腐蚀性食管损伤的手术治疗与结果：来自也门萨那的一项前瞻性研究

Surgical management and outcomes of corrosive esophageal injuries: a prospective study from Sana'a, Yemen.

作者信息

Al-Shehari Mohammed Mohammed, Obadiel Yasser Abdurabo, Al-Helali Ahmed Hamood, Jowah Haitham Mohammed

机构信息

Department of Surgery, Faculty of Medicine and Health Science, Sana'a University, Sana'a City, Yemen.

Department of Surgery, Al-Thawra Modern General Hospital, Sana'a City, Yemen.

出版信息

BMC Surg. 2025 Jul 3;25(1):272. doi: 10.1186/s12893-025-03027-z.

DOI:10.1186/s12893-025-03027-z

PMID:40611113

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12232069/

Abstract

BACKGROUND

Corrosive esophageal injuries pose a significant health burden in resource-limited settings like Yemen. This study evaluated the demographic patterns, clinical presentations, management strategies, and outcomes of patients with corrosive esophageal injuries at a tertiary hospital in Sana’a, Yemen.

METHODS

This prospective single-center study at Al-Thawra Modern General Hospital, Sana’a, Yemen (January 2021–June 2024) enrolled 22 patients with corrosive esophageal injuries. Data on demographics, corrosive agents, clinical features, endoscopic findings, management, and outcomes were analyzed using chi-square tests and ANOVA ( < 0.05).

RESULTS

The mean patient age was 24.7 ± 17.0 years, with 40.9% ( = 9) under 20 years. Accidental ingestion, primarily acidic agents (68.2%, = 15), accounted for 90.9% ( = 20) of the cases. Dysphagia was the most common symptom (90.9%, = 20). Endoscopy revealed Grade 2B injuries in 59.1% ( = 13), using the endoscope unable to pass in 13.6% ( = 3). Strictures developed in 36.4% ( = 8) of patients. Endoscopic dilation (ED) was attempted in 77.3% ( = 17), achieving durable symptomatic improvement in 58.8% ( = 10/17). Surgical interventions, including colonic conduit ( = 6) and gastric pull-up ( = 2), were performed in 36.4% ( = 8). Complications occurred in 45.5% ( = 10), and mortality was 13.6% ( = 3), significantly associated with suicidal ingestion ( = 0.001).

CONCLUSION

Corrosive esophageal injuries in Yemen, mostly accidental, affect younger patients and result in high morbidity (45.5%). ED is effective for single strictures, but severe cases often require surgery. Gastric pull-up appeared to have lower complications than colonic conduit in this small cohort, although larger studies are needed to confirm this trend. The elevated mortality rate among suicidal cases highlights the need for mental health support. The small sample size ( = 22) and single-center design limit generalizability, necessitating larger multicenter studies to optimize management strategies.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12893-025-03027-z.

摘要

背景

在也门等资源有限的地区，腐蚀性食管损伤带来了巨大的健康负担。本研究评估了也门萨那一家三级医院中腐蚀性食管损伤患者的人口统计学模式、临床表现、管理策略及治疗结果。

方法

这项在也门萨那的宰赫拉现代综合医院开展的前瞻性单中心研究（2021年1月至2024年6月）纳入了22例腐蚀性食管损伤患者。使用卡方检验和方差分析（<0.05）对人口统计学、腐蚀剂、临床特征、内镜检查结果、管理措施及治疗结果等数据进行分析。

结果

患者的平均年龄为24.7±17.0岁，40.9%（n = 9）的患者年龄在20岁以下。意外摄入，主要是酸性物质（68.2%，n = 15），占所有病例的90.9%（n = 20）。吞咽困难是最常见的症状（90.9%，n = 20）。内镜检查显示59.1%（n = 13）的患者为2B级损伤，13.6%（n = 3）的患者内镜无法通过。36.4%（n = 8）的患者出现了狭窄。77.3%（n = 17）的患者尝试了内镜扩张（ED），其中58.8%（n = 10/17）的患者症状得到了持久改善。36.4%（n = 8）的患者接受了手术干预，包括结肠代食管术（n = 6）和胃上提术（n = 2）。45.5%（n = 10）的患者出现了并发症，死亡率为13.6%（n = 3），与自杀性摄入显著相关（P = 0.001）。

结论

也门的腐蚀性食管损伤大多为意外，影响年轻患者，且发病率较高（45.5%）。内镜扩张对单一狭窄有效，但严重病例通常需要手术治疗。在这个小队列中，胃上提术的并发症似乎比结肠代食管术少，不过需要更大规模的研究来证实这一趋势。自杀病例中死亡率升高凸显了心理健康支持的必要性。样本量小（n = 22）和单中心设计限制了研究结果的普遍性，需要开展更大规模的多中心研究来优化管理策略。