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食管瘘:内镜下甲状腺切除术后的严重并发症:一例报告及文献综述

Esophageal fistula: serious complication after endoscopic thyroidectomy : A case report and literature review.

作者信息

Xu Jiamin, Zhou Ying, Lin Juan, He Huihong

机构信息

Department of Breast and Thyroid Surgery, Shaoxing People's Hospital, The First Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China.

出版信息

Medicine (Baltimore). 2025 Aug 29;104(35):e44216. doi: 10.1097/MD.0000000000044216.

Abstract

RATIONALE

Esophageal fistula is a rare and serious complication after endoscopic thyroidectomy. Current research focuses more on surgical treatment, while there are few treatment plans for esophageal fistula after endoscopic thyroidectomy. There is currently no standardized intervention for esophageal fistula after thyroid surgery.

PATIENT CONCERNS

The patient wants to cure the esophageal fistula as soon as possible and does not want to have other complications.

DIAGNOSES

The patient was diagnosed with thyroid cancer.

INTERVENTIONS

We summarize the key points of interventions as follows: First, a comprehensive assessment of the patient's condition was conducted before the surgery, and an individualized surgical approach was formulated. During the operation, preventive intervention measures were carried out. Second, after the surgery, fasting, gastrointestinal decompression, and supportive treatment were provided. Then, an individualized follow-up plan was developed after discharge to prevent long-term complications. At the same time, the negative emotions of the patients were also paid attention to, and timely counseling was given to help them return to society as soon as possible.

OUTCOMES

The patient was hospitalized for 35 days. After the joint efforts of doctors, nurses, and patients, she recovered well and was discharged from the hospital 31 days after surgery. Two-month follow-up after discharge showed that gastrointestinal function recovered well, with no abdominal pain, bloating, diarrhea, nausea, vomiting, and other discomforts, and no long-term complications such as esophageal stenosis.

LESSONS

The interventions we summarized are effective and feasible for patients with esophageal fistula after endoscopic thyroidectomy.

摘要

理论依据

食管瘘是内镜下甲状腺切除术后一种罕见且严重的并发症。目前的研究更多聚焦于手术治疗,而内镜下甲状腺切除术后食管瘘的治疗方案较少。目前甲状腺手术后食管瘘尚无标准化的干预措施。

患者关注点

患者希望尽快治愈食管瘘,且不想出现其他并发症。

诊断结果

患者被诊断为甲状腺癌。

干预措施

我们将干预要点总结如下:首先,术前对患者病情进行全面评估,制定个体化手术方案。术中采取预防性干预措施。其次,术后给予禁食、胃肠减压及支持治疗。然后,出院后制定个体化随访计划以预防远期并发症。同时,也关注患者的负面情绪,及时给予心理疏导,帮助其尽快回归社会。

治疗结果

患者住院35天。经过医生、护士和患者的共同努力,她恢复良好,术后31天出院。出院后两个月随访显示,胃肠功能恢复良好,无腹痛、腹胀、腹泻、恶心、呕吐等不适,也无食管狭窄等远期并发症。

经验教训

我们总结的干预措施对于内镜下甲状腺切除术后食管瘘患者是有效且可行的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08e0/12401441/920d219a3b93/medi-104-e44216-g001.jpg

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