Salami Aitua C, Rao Madhuri, Berger Jonathan, Diaz-Gutierrez Ilitch, Khariwala Samir S, Khaja Sobia F, Sembrano Jonathan N, Hunt Matthew, Andrade Rafael, Bhargava Amit
Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn.
Department of Otolaryngology, Head, and Neck Surgery, University of Minnesota, Minneapolis, Minn.
JTCVS Tech. 2024 Mar 29;25:208-213. doi: 10.1016/j.xjtc.2024.03.014. eCollection 2024 Jun.
To report our updated experience in the management of esophageal perforation resulting from anterior cervical spine surgery, and to compare two wound management approaches.
This is a retrospective review of patients managed for esophageal perforations resulting from anterior cervical spine surgery (2007-2020). We examine outcomes based on 2 wound management approaches: closed (closed incision over a drain) versus open (left open to heal by secondary intention). We collected data on demographics, operative management, resolution (resumption of oral intake), time to resolution, number of procedures needed for resolution, microbiology, length of stay, and neck morbidity.
A total of 13 patients were included (10 men). Median age was 52 years (range, 24-74 years). All patients underwent surgical drainage, repair, or attempted repair of perforation, hardware removal, and establishment of enteral access. Wounds were managed closed versus open (6 closed, 7 open). There were 2 early postoperative deaths due to acute respiratory distress syndrome and aspiration (open group), and 1 patient was lost to follow-up (closed group). Among the remaining 10 patients: resolution rate was 80% versus 100%, resolution in 30 days was 20% versus 100%, median number of procedures needed for resolution was 3 versus 1, and median hospital stay was 23 versus 14 days, for the closed and open groups, respectively.
Esophageal perforation following anterior cervical spine surgery should be managed in a multidisciplinary fashion with surgical neck drainage, primary repair when feasible, hardware removal, and establishment of enteral access. We advocate open neck wound management to decrease the time-to-resolution, number of procedures, and length of stay.
报告我们在颈椎前路手术所致食管穿孔管理方面的最新经验，并比较两种伤口处理方法。
这是一项对因颈椎前路手术导致食管穿孔患者（2007 - 2020年）的回顾性研究。我们基于两种伤口处理方法来检查结果：闭合式（在引流管上方闭合切口）与开放式（敞开伤口通过二期愈合）。我们收集了有关人口统计学、手术管理、穿孔解决情况（恢复经口进食）、解决时间、解决所需手术次数、微生物学、住院时间和颈部并发症的数据。
共纳入了13例患者（10例男性）。中位年龄为52岁（范围24 - 74岁）。所有患者均接受了手术引流、穿孔修复或尝试修复、内固定取出以及建立肠内通路。伤口采用闭合式与开放式处理（6例闭合式，7例开放式）。有2例患者术后早期因急性呼吸窘迫综合征和误吸死亡（开放式组），1例患者失访（闭合式组）。在其余10例患者中：闭合式组与开放式组的穿孔解决率分别为80%和100%，30天内解决率分别为20%和100%，解决所需的中位手术次数分别为3次和1次，中位住院时间分别为23天和14天。
颈椎前路手术后的食管穿孔应采用多学科方式处理，包括颈部手术引流、可行时进行一期修复以及内固定取出和建立肠内通路。我们提倡采用开放式颈部伤口处理方法，以减少解决时间、手术次数和住院时间。
