Symbas P N, Vlasis S E, Hatcher C R
Ann Thorac Surg. 1983 Jul;36(1):73-7. doi: 10.1016/s0003-4975(10)60653-4.
The records of 176 patients admitted to Grady Memorial Hospital over a 10-year period with a history of ingestion of corrosive material were reviewed. Esophagoscopy was performed in 168 patients an average of 15 hours after ingestion. In 94 patients, no esophageal burn was found. Seventy-four others had injury of the esophagus of varying degree; 3 of these had no evidence of oropharyngeal burn. The patients with esophageal injury were treated with steroids for two weeks and antibiotics for 5 days. No complications resulted from esophagoscopy or steroid therapy in any patient. Stricture did not develop in any of the patients in whom esophagoscopy was negative. Documented stricture occurred in 29 patients with esophagoscopic evidence of esophageal burns, 7 of whom did not respond to periodic esophageal dilation and subsequently underwent esophageal bypass. Three patients had symptoms and signs of gastric perforation on the first, sixth, and eighth days after ingestion, respectively, and at laparotomy all of them were found to have severe gastric injury. One of these patients died on the postoperative day 28; this was the only death among all patients seen with history of ingestion of corrosive material. This study suggests that with early esophagoscopy, approximately 55% of patients who ingest corrosive material can be spared the agony and prolonged treatment of possible esophageal injury. Appropriate management will result in preservation of the esophagus in most patients.
回顾了格雷迪纪念医院10年间收治的176例有腐蚀性物质摄入史患者的病历。168例患者在摄入后平均15小时接受了食管镜检查。94例患者未发现食管烧伤。另外74例有不同程度的食管损伤；其中3例无口咽烧伤迹象。食管损伤患者接受了两周的类固醇治疗和5天的抗生素治疗。所有患者均未因食管镜检查或类固醇治疗出现并发症。食管镜检查阴性的患者均未发生狭窄。29例有食管镜检查证据显示食管烧伤的患者出现了记录在案的狭窄，其中7例对定期食管扩张无反应，随后接受了食管旁路手术。3例患者分别在摄入后的第1天、第6天和第8天出现胃穿孔的症状和体征，剖腹手术时发现他们均有严重的胃损伤。其中1例患者在术后第28天死亡；这是所有有腐蚀性物质摄入史患者中唯一的死亡病例。这项研究表明，通过早期食管镜检查，大约55%摄入腐蚀性物质的患者可以避免可能的食管损伤带来的痛苦和长期治疗。适当的处理将使大多数患者的食管得以保留。
