Mäkelä J T, Laitinen S, Salo J A
Department of Surgery, Oulu University Hospital, Finland.
Eur J Surg. 1998 Aug;164(8):575-80. doi: 10.1080/110241598750005660.
To review our experience of 9 patients who had attempted suicide by swallowing alkaline substances.
Retrospective study.
Two university hospitals, Finland.
During the years 1987-1996. 9 patients who had swallowed more than 100 ml of strong alkali.
2 patients with oesophagorespiratory fistulas of the four with third degree injuries died in hospital, the first died of overwhelming sepsis and the second of multiple organ failure. The other two survived emergency staged resection and subsequent reconstruction. Delay between swallowing the alkali and the initial operation, and development of oesophagorespiratory fistulas were the most important predictors of death. Four patients with second degree injuries underwent oesophageal resection and reconstruction after they had developed oesophageal strictures. Two of these six survivors developed anastomotic strictures after reconstruction, both of which necessitated repeated oesophageal dilatations. One patient with a first degree injury was treated conservatively.
An early and aggressive approach to severe third degree corrosive injuries of the upper gastrointestinal tract is needed to resect all necrotic tissue and to make it possible to do a successful reconstruction later. The development of oesophagorespiratory fistulas requires immediate attention, whereas first and second degree injuries can be treated after the patient has been stabilized.
回顾我们对9例吞服碱性物质自杀患者的治疗经验。
回顾性研究。
芬兰的两家大学医院。
1987年至1996年期间，9例吞服超过100毫升强碱的患者。
4例三度损伤患者中有2例发生食管气管瘘，在医院死亡，第一例死于严重败血症，第二例死于多器官功能衰竭。另外2例患者在接受急诊分期切除及后续重建手术后存活。吞服碱液至初次手术的间隔时间以及食管气管瘘的发生是死亡的最重要预测因素。4例二度损伤患者在出现食管狭窄后接受了食管切除及重建手术。这6例幸存者中有2例在重建后出现吻合口狭窄，均需要反复进行食管扩张。1例一度损伤患者接受了保守治疗。
对于上消化道严重三度腐蚀性损伤，需要尽早采取积极治疗措施，切除所有坏死组织，以便后期能够成功进行重建。食管气管瘘的发生需要立即关注，而一度和二度损伤可在患者病情稳定后进行治疗。
