颈椎前路手术并发食管瘘的治疗

Treatment of esophageal perforation after anterior cervical spine surgery

目的 :探讨颈椎前路手术并发食管瘘的治疗措施及其效果。方法 :回顾性分析2006年9月~2016年7月颈椎前路手术并发食管瘘的8例患者资料,其中男6例,女2例;年龄31~71岁(52.32±13.05岁)。外伤性颈椎骨折4例(其中强直性脊柱炎2例),颈椎病2例,颈椎结核1例,颈椎畸形1例。术中发现食管瘘1例,当即给予修补;术后早发性(1个月内)食管瘘6例,其中2例经呋喃西林纱布条换药处理,2例行清创探查引流术并在术中给予修补,1例清创探查术后给予胸锁乳突肌瓣填塞,1例因脓毒血症死亡;迟发性(1个月后)食管瘘1例,行内固定取出清创探查,并肌瓣填塞。同时所有患者行伤口细菌培养,应用敏感抗生素,鼻饲饮食加强营养等治疗。结果:1例强直性脊柱炎合并颈椎骨折脱位患者,于术后第4天出现食管瘘,术后第7天因脓毒血症死亡;其余7例食管瘘口均愈合,愈合时间为2周~2.5个月;随访1~5年(2.86±1.36年),7例均无复发,且吞咽功能良好。结论:依据食管瘘发生的时间,结合其大小和污染程度采取不同的治疗方案,可取得较好的疗效。

Objectives： To investigate treatment strategy of esophageal perforation caused by anterior cervical spine surgery. Methods： A retrospective analysis was performed on 8 cases of anterior cervical operation with esophageal fistula diagnostic criteria from September 2006 to July 2016, including 6 males and 2 females. The mean age was 52.32 years（range from 31 to 71 years）. Among them, cervical spine fracture was caused by trauma in 4 cases（including 2 cases of ankylosing spondylitis）, 2 cases of cervical spondylosis, 1 case of cervical tuberculosis, and 1 case of cervical deformity. 1 case was found during the operation and repaired immediately; esophageal fistula occurred in 6 patients during early postoperative phase（less than 1 month）, in- cluding nitrofurazone gauze dressing treatment in 2 cases, debridement and exploration of drainage performance in 2 cases, debridement and laparotomy after sternocleidomastoid muscle flap packing conduct in 1 case. Esophageal fistula occurred in 1 patient during the late phase（more than 1 month）, internal fixation was removed and debridement plus muscle flaps were performed. At the same time, all of the patients were treated with wound bacterial culture, antibiotics and nasal feeding nutrition. Results： Among 8 cases of anterior cervical operation with esophageal fistula diagnostic criteria, 1 case who was ankylosing spondylitis with cervi- cal spine fractures and dislocations appeared esophageal fistula at 4 days after operation, and died due to sepsis at 7 days after operation. The other 7 cases were healed at 2 weeks to 2.5 months after treatment with an average of （2.86±1.36） years followed-up（range, 1-5 years）. There was no recurrence of esophageal fistula and the swallowing function was good. Conclusions： The satisfactory effect may be achieved by choosing appropriate methods for different kinds of time, size and pollution levels of esophageal perforation.