Llorente Kaysey, Evans Morgan, Moore Sarah A, Miskimins Richard
University of New Mexico Hospital, Department of Acute Care and Trauma Surgery, United States of America.
Trauma Case Rep. 2022 Dec 31;43:100748. doi: 10.1016/j.tcr.2022.100748. eCollection 2023 Feb.
Esophageal trauma is rare and associated with high morbidity and mortality. Management can be challenging. Operative intervention involves exposure of the esophageal injury followed by primary two-layer repair with or without a buttressing muscle flap and wide local drainage. Repair can be complicated by post-operative leak and esophagocutaneous fistula. Endoluminal wound VAC therapy in the management of non-traumatic and iatrogenic esophageal perforations has shown efficacy. Presented here is a case series of four patients who sustained penetrating trauma to the esophagus and were managed successfully with endoluminal wound VAC therapy following primary repair. Therefore, endoscopic placement of an endoluminal wound VAC over the site of esophageal injury can serve as a safe and effective adjunct to primary repair of penetrating esophageal trauma. This procedure allows for frequent direct visualization of the injury as it heals, controls leakage of luminal contents, and promotes granulation for local wound healing.
食管创伤较为罕见,且与高发病率和死亡率相关。其治疗颇具挑战性。手术干预包括暴露食管损伤部位,然后进行有或无支撑肌瓣的一期两层修复以及广泛的局部引流。修复可能会因术后渗漏和食管皮肤瘘而变得复杂。腔内创面负压封闭引流疗法在非创伤性和医源性食管穿孔的治疗中已显示出疗效。本文介绍了一组4例食管穿透伤患者的病例系列,这些患者在一期修复后采用腔内创面负压封闭引流疗法成功治愈。因此,在内镜下将腔内创面负压封闭引流装置放置在食管损伤部位,可作为穿透性食管创伤一期修复的一种安全有效的辅助手段。该方法能够在损伤愈合过程中频繁直接观察损伤情况,控制管腔内内容物的渗漏,并促进局部创面愈合的肉芽组织形成。