极低出生体重儿聚乙烯饲管的使用和医源性咽-食管穿孔

Abstract Abstract Background: Placement of a feeding tube may be associated with various complications, including iatrogenic pharyngooesophageal perforation. Aim: To determine the incidence of pharyngo-oesophageal perforation secondary to the use of polyvinyl feeding tubes in newborns weighing less than 1500 g, we conducted a retrospective study over a 3 12-y period. Methods: All the hospital files of the 371 very-low-birthweight newborns admitted were retrospectively reviewed. Results: Three iatrogenic pharyngo-oesophageal perforations were observed, giving an incidence of 1 : 124 preterm infants. This incidence reaches values of 1 : 25 newborns weighing less than 750 g. Data from our cases included clinical presentation and outcome, radiological evaluation, and type of feeding tube. One infant died of sepsis, and the clinical course was compatible with mediastinitis. The other two infants were treated successfully with conservative non-surgical management. Conclusion: Pharyngo-oesophageal perforation in our experience exclusively involved preterm infants weighing less than 750 g after traumatic placement of a polyvinyl feeding tube. The use of a silastic feeding tube with a really soft end instead of polyvinyl catheters could probably avoid iatrogenic oesophageal perforation.

食管穿孔和破裂的诊断与治疗

目的 提高对食管穿孔和破裂的诊断及处理水平。方法 回顾性分析经外科处理的45例食管穿孔或破裂患者的临床资料。结果 本组患者经胸部平片、胸腔穿刺、上消化道造影及胃镜确诊。15例为自发性食管破裂,6例为医源性穿孔,5例为创伤性穿孔,10例为食管癌并食管支气管瘘,9例为食管憩室并食管支气管瘘。治疗予以食管修补9例;胸腔引流、空肠造瘘9例(其中1例为食管修补失败后改行此手术者);食管切除胃食管吻合术12例(其中3例为食管修补失败者);胃造瘘术4例;置入食管支架4例;食管支气管瘘切除修补3例;食管瘘口修补并肺叶切除2例;食管胃弓上短路1例,颈部引流2例;放弃治疗3例。治愈25例,好转11例,死亡6例。结论 详细了解病史和进行胸腔穿刺、上消化道造影等检查可帮助诊断。尽早手术闭合瘘口和治疗食管原发病变是治疗的关键。

食管穿孔后保守治疗的疗效分析

食管穿孔的常见原因有异物性、医源性，随着近年来食管内镜和介入治疗的广泛开展，医源性食管穿孔有明显增多的趋势。2001年4月至2005年4月我院胸外科共收治食管穿孔患者20例，其中10例采取保守治疗，疗效满意，现报告如下。