Di Costanzo J, Noirclerc M, Jouglard J, Escoffier J M, Cano N, Martin J, Gauthier A
Gut. 1980 May;21(5):370-5. doi: 10.1136/gut.21.5.370.
The therapeutic approach to the management of corrosive burns of the upper gastrointestinal tract leaves a considerable morbidity and a heavy mortality rate. This work evaluates the effectiveness of a new therapeutic approach given to 94 consecutive patients. The management has been based on three major points: (1) the definition of extent of upper gastrointestinal lesions by immediate fibroendoscopy; (2) immediate protection of the upper gastrointestinal tract by total parenteral nutrition in cases with serious burns (41 cases), normal oral nutrition being allowed for minor burns (35 cases); (3) reparative surgical procedures for any of the sequelae of such burns during the fibrosing phase. The results were as follows: (a) healing, depending upon the degree of burn, occurred between eight to 90 days; (b) the frequency of subsequent local complications was small with total parenteral nutrition started a few hours after ingestion of the corrosive product; (c) after reconstructive surgery no serious complications occurred; (d) the overall morbidity stayed at a very low level (four patients). We conclude that the general prognosis of a severe burn of the upper gastrointestinal tract, without other trauma, is appreciably improved by the very early institution of total parenteral nutrition.
上消化道腐蚀性烧伤的治疗方法导致了相当高的发病率和死亡率。这项研究评估了对94例连续患者采用的一种新治疗方法的有效性。治疗基于三个要点：（1）通过即时纤维内镜检查确定上消化道病变的范围；（2）对于严重烧伤患者（41例），通过全胃肠外营养立即对上消化道进行保护，轻度烧伤患者（35例）允许正常经口营养；（3）在纤维化阶段对这类烧伤的任何后遗症进行修复性外科手术。结果如下：（a）根据烧伤程度，愈合时间在8至90天之间；（b）在摄入腐蚀性物质后数小时内开始全胃肠外营养，随后局部并发症的发生率较低；（c）重建手术后未发生严重并发症；（d）总体发病率维持在非常低的水平（4例患者）。我们得出结论，对于无其他创伤的严重上消化道烧伤，极早期实施全胃肠外营养可显著改善总体预后。
