Armstrong W B, Detar T R, Stanley R B
Department of Otolaryngology--Head and Neck Surgery, University of Southern California, Los Angeles.
Ann Otol Rhinol Laryngol. 1994 Nov;103(11):863-71. doi: 10.1177/000348949410301107.
External penetrating injuries of the esophagus are more likely to cause serious morbidity and even mortality than those involving the pharynx. However, the cervical esophagus is extrathoracic in location, and controversy exists regarding the diagnosis and surgical management of penetrating injuries at this level. A retrospective review of 23 such injuries showed that contrast esophagography had only a 62% success rate in identification of cervical esophageal violations, compared to 100% for rigid esophagoscopy. Even large penetrations were successfully treated with limited debridement, primary repair when possible, muscle interposition flaps to separate common injuries of the tracheal wall, and, most important, external drainage of the adjacent neck spaces. Esophageal stricture occurred only when complex esophageal diversion procedures were performed, either as an unnecessary primary operation, or as a lifesaving secondary operation necessitated by infectious complications caused by delayed diagnosis and treatment of the esophageal violation. Penetrating injuries of the cervical esophagus can therefore be managed more as a pharyngeal injury if diagnosis and appropriate surgical treatment occur in a timely fashion.
与涉及咽部的穿透伤相比，食管的外部穿透伤更有可能导致严重的发病率甚至死亡率。然而，颈段食管位于胸外，对于该部位穿透伤的诊断和手术处理存在争议。一项对23例此类损伤的回顾性研究表明，食管造影对颈段食管损伤的识别成功率仅为62%，而硬质食管镜检查的成功率为100%。即使是较大的穿透伤，也可通过有限的清创、尽可能进行一期修复、采用肌瓣间置以分隔常见的气管壁损伤，以及最重要的是对相邻颈部间隙进行外部引流来成功治疗。只有在进行复杂的食管转流手术时才会发生食管狭窄，这种手术要么是不必要的一期手术，要么是因食管损伤诊断和治疗延迟导致感染并发症而必需的挽救生命的二期手术。因此，如果能及时进行诊断和适当的手术治疗，颈段食管穿透伤的处理方式可更类似于咽部损伤。
