Chobarporn Thitiporn, Mesiri Dudsadee, Tharavej Chadin
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
Department of Surgery, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
Surg Today. 2025 Apr;55(4):526-536. doi: 10.1007/s00595-024-02928-5. Epub 2024 Aug 23.
Emergency surgery can save patients' lives in cases of severe caustic injury. However, the long-term outcomes are not well understood.
Patients who underwent emergency organ resection for severe corrosive acid injury were included. Subsequently, digestive tract reconstruction was performed to fit patients. Long-term outcomes were analyzed.
Fifty patients underwent emergency digestive tract resection. The operative mortality rate was 6% (of 3/50). One of the 50 patients underwent successful immediate reconstruction. Of the 46 survivors with digestive tract discontinuity, 32 (70%) underwent subsequent reconstructive surgery, 10 (22%) died while awaiting reconstruction due to deterioration in their psychiatric and nutritional status, and 4 (9%) were unfit for reconstructive surgery. No operative mortality occurred during reconstruction. Among the 32 patients who underwent reconstruction, 30 (94%) achieved nutritional autonomy. Nutritional independence was achieved in 62% of the patients (31/50). At a median duration of 58 months, the median survival time of the 50 patients was 158 months. Patients who underwent reconstruction had a significantly better overall survival than those who did not (p < 0.0001).
Emergency surgery remains the standard treatment for corrosive ingestion of complicated digestive tract injuries. However, only 60% of survivors can undergo subsequent digestive reconstruction and achieve long-term nutritional autonomy and a survival outcome.
在严重腐蚀性损伤的情况下，急诊手术可挽救患者生命。然而，其长期预后尚不清楚。
纳入因严重腐蚀性酸损伤接受急诊器官切除的患者。随后进行消化道重建以适配患者，并分析长期预后。
50例患者接受了急诊消化道切除术。手术死亡率为6%（3/50）。50例患者中有1例立即成功重建。在46例消化道连续性中断的幸存者中，32例（70%）接受了后续重建手术，10例（22%）因精神和营养状况恶化在等待重建期间死亡，4例（9%）不适合进行重建手术。重建过程中未发生手术死亡。在接受重建的32例患者中，30例（94%）实现了营养自主。50例患者中有62%（31/50）实现了营养独立。在中位时间58个月时，50例患者的中位生存时间为158个月。接受重建的患者总体生存率明显高于未接受重建的患者（p < 0.0001）。
急诊手术仍然是腐蚀性消化道复杂损伤的标准治疗方法。然而，只有60%的幸存者能够接受后续消化道重建并实现长期营养自主和生存结局。
