高危胸段食管异物18例的急诊手术治疗

Emergency surgery of high risk thoracic esophageal foreign body in 18 cases

目的分析高危胸段食管异物急诊手术治疗资料,探讨其手术适应证及手术方法。方法回顾分析2000年2月—2009年5月18例高危胸段食管异物的临床特点、手术方法、围手术期处理。结果手术取除异物采用左颈前切口1例,右侧胸切口13例,左侧胸切口4例。全组无围术期死亡。2例合并食管穿孔者术后并发左侧脓胸,经充分引流、肠内外营养支持等治疗后分别于术后第8周、13周治愈;其余16例患者术后5～14d恢复经口进食,15～20d治愈出院。所有患者出院前食管钡餐X线复查均无明显食管狭窄及食管瘘存在,随访1～3个月进食良好,无特异不适。讨论胸段食管异物内窥镜下取出失败、不规整的尖锐异物、已嵌顿食管壁的异物、食管异物合并穿孔者应急诊外科手术,明确诊断后24h内手术可降低其病死率。

Objective To summarize high risk thoracic segment esophageal foreign body emergency operation treatment data,investigate the surgical indications and surgical methods.Methods The clinical features,surgical approaches,perioperative treatments of 18 patients from February 2000 to May 2009 were analyzed retrospectively.There were 2 cases with esophageal perforation and 1 case with pneumomediastinum.Results Foreign bodies were removed at the left neck anterior incision in 1 case,right chest incision in 13 cases and left chest incision in 4 cases.There was no death.Sixteen patients took food through mouth from the fifth day to the fourteenth day,and were cured and discharged during 15 days to 20 days after surgery. There was a good prognosis and no clinical symptoms found during 1～3 months follow up.Conclusion Patients with thoracic segment esophageal foreign bodies taking failure through endoscope,irregular sharp,with embedded pipe wall,and with esophageal perforation should taken emergency surgery.The mortality would be decreased if the surgery can be carried out after diagnoses in 24 hours.