颈椎前路内固定术后中远期食管并发症

Delayed esophageal complications after anterior cervical spine surgery

目的探讨颈椎前路内固定术后中远期食管并发症的发生率及其诊疗策略。方法对2001年1月至2011年12月2316例行颈椎前路内固定手术患者发生的中远期食管并发症情况进行回顾性分析。食管中远期并发症包括术后2周以上发生的食管穿孔、食管气管瘘、食管皮下瘘、食管憩室、食管胸膜瘘及食管狭窄等。结果共4例患者发生中远期食管并发症，发生率为0．17％（4／2316），其中食管穿孔发生率为0．09％（2例）。病例1为31岁男性患者，自体髂骨移植融合加钢板内固定（C5）术后7年发现食管憩室合并食管穿孔。手术取出内固定，清创后切除憩室，胸骨舌骨肌及肩胛舌骨肌肌瓣修补食管。病例2为46岁男性患者，自体髂骨移植融合加钢板内固定（C5）术后3年发现食管憩室。手术取出内固定，切除食管憩室，胸骨舌骨肌及肩胛舌骨肌肌瓣修补食管。病例3为58岁女性患者，自体髂骨移植融合加钢板内固定（C6）术后5年出现食管憩室。手术取出内固定，切除食管憩室，胸锁乳突肌肌瓣修补食管。病例4为56岁女性患者，钛网植骨融合加钢板内固定（C6）术后3年出现食管穿孔。手术取出内固定，清创后胸锁乳突肌肌瓣修补食管。4例患者术后食管并发症均获得成功治疗，恢复良好。结论颈椎前路内固定术后中远期食管并发症的发生率较低，X线片、消化道造影及消化道内镜检查是主要的诊断方法，手术是其主要的治疗手段。

Objective To investigate incidence, diagnosis and treatment strategy of delayed esophageal complications after anterior cervical spine surgery. Methods The clinical data of 2316 patients who had undergone anterior cervical spine surgery from January 2001 to December 2011 were analyzed. The delayed esophageal complications were defined as esophageal perforation, esophago-tracheal fistula, esophago-cutaneous fistula, diverticulum of esophagus, esophagopleural fistula and esophageal stenosis that occurred 2 weeks after spine surgery. Results Delayed esophageal complications occurred in 4 patients, and the incidence was 0.17%. Esophageal perforation occurred in 2 patients; the incidence was 0.09%. Case 1 was a 31-year-old man who was found to have esophageal diverticulum and perforation 7 years after anterior cervical spine surgery. Then he underwent removal of implant, excision of diverticulum, and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap. Case 2 was a 46-year-old man who was found to have esophageal diverticulum 3 years after cervical spine surgery. He also underwent removal of implant, excision of diverticulum, and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap. Case 3 was a 58-year-old woman who was found to have esophageal diverticulum 5 years after cervical spine surgery. She underwent removal of implant, excision of diverticulum, and repair of esophagus with sternocleidomastoid muscle flap. Case 4 was a 56-year-old woman who was found to have esophageal perforation 3 years after cervical spine surgery. She underwent removal of implant and repair of esophagus with sternocleidomastoid muscle flap. All 4 patients recovered after operation. Conclusion The incidence of delayed esophageal complications after anterior cervical spine surgery is low, and the diagnosis is difficult. X-ray, digestive tract radiography, and gastrointestinal endoscopy are the main diagnostic tools. Surgical treatment is the main and effective management.