Lai K H, Huang B S, Huang M H, Huang M S, Wu J K, Liu M, Lee C H
Department of Emergency Medicine, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1995 Jul;56(1):40-6.
In treating severe corrosive injury of the esophagus and stomach, prompt diagnosis, adequate fluid resuscitation and warranted surgical intervention are the most important factors in rescue of critically ill patients. The purpose of this study was to evaluate the need for, and the advantages of, a surgical approach to treatment of such corrosive injuries to the upper gastrointestinal (UGI) tract, as well as to select the most suitable technique to achieve a good survival rate.
From January 1983 to December 1991, 220 patients were treated for caustic ingestion injury to the UGI tract. A retrospective review of their records allowed targeting of 27 patients with severe corrosive injury that surgical intervention was required. In this study, peritoneal sign was taken as the key indicator for early emergency operation. The age, sex, elapsed time from injury to operation, the sort and quantity of caustic agent used, injury mechanism, clinical manifestations, alternative surgical treatment methods and causes of death were also reviewed and analyzed in this study.
The patients included 13 men and 14 women, of whom the majority were adults (96.3%) who had attempted suicide (85.2%). All of them had taken liquid corrosive agents, usually hydrochloric acid (63%). Eighteen underwent emergency operations; the other nine received only supportive treatment, given their terminal status. The mortality rates for patients with surgery and supportive treatment were 66.7% and 100%, respectively. Four patients died after undergoing esophagectomy with resection of the stomach using the thoracoabdominal method. Only three of the eight patients who received esophageal stripping combined with resection of the stomach through the abdomen died (37.5%).
The time elapsed between injury and development of peritoneal sign is a good indicator of the severity and extent of the injury. When peritoneal sign manifests at a very early stage, it is an indicator that the corrosive injury is very advanced in its progress and that, no matter what procedures were performed, the outcome would be the same. Yet if there were a six-hour gap then aggressive surgical management can rescue some patients. It is recommended based on experience here, that when using the surgical approach, resection of the stomach with stripping of the esophagus is superior to the thoracoabdominal method.
在治疗食管和胃的严重腐蚀性损伤时，及时诊断、充分的液体复苏和必要的手术干预是抢救重症患者的最重要因素。本研究的目的是评估对上消化道（UGI）腐蚀性损伤采取手术治疗的必要性和优势，并选择最合适的技术以实现良好的生存率。
1983年1月至1991年12月，220例患者因腐蚀性物质摄入导致上消化道损伤接受治疗。通过回顾他们的病历，确定了27例需要手术干预的严重腐蚀性损伤患者。在本研究中，腹膜征被视为早期急诊手术的关键指标。还对患者的年龄、性别、受伤至手术的时间、所用腐蚀性物质的种类和数量、损伤机制、临床表现、替代手术治疗方法及死亡原因进行了回顾和分析。
患者包括13名男性和14名女性，其中大多数为成年人（96.3%），且多为自杀未遂（85.2%）。他们均摄入了液体腐蚀性物质，通常为盐酸（63%）。18例接受了急诊手术；另外9例因病情晚期仅接受了支持治疗。接受手术和支持治疗的患者死亡率分别为66.7%和100%。4例患者采用胸腹联合方法行食管切除并胃切除术后死亡。8例经腹部行食管剥脱联合胃切除的患者中仅3例死亡（37.5%）。
受伤至出现腹膜征的时间是损伤严重程度和范围的良好指标。当腹膜征在极早期出现时，表明腐蚀性损伤进展已非常严重，无论采取何种手术方式，结果都相同。然而，如果有6小时的间隔期，积极的手术治疗可挽救部分患者。基于本研究经验，建议手术时采用食管剥脱联合胃切除优于胸腹联合方法。
