Anterior cervical spine surgery for traumatic or degenerative disease is a well-established procedure. However, complications such as pharyngoesophageal perforation can occur. In this study, we report a series of 6 ph...Anterior cervical spine surgery for traumatic or degenerative disease is a well-established procedure. However, complications such as pharyngoesophageal perforation can occur. In this study, we report a series of 6 pharyngoesophageal perforations after surgery. Based on the literature review, we analyzed pathogenesis, diagnosis and discussed therapeutic strategies. Three cases occurred after surgeries of traumatic cervical spine whereas the remaining were after surgeries for degenerative cervical myelopathy. The mean duration of surgery was 210 minutes. The symptoms, appearing 48 hours after surgery, were commonly hyperthermia, dysphagia, sore throat and swelling of the incision site. The diagnostic was confirmed after contrast-enhanced esophagography. The treatment strategies consisted of insertion of nasogastric feeding tube, oral intake restriction, intravenous antibiotics administration, wound drainage. Reoperation was necessary in 4 cases with removal of the hardware in three of them. One death occurred by pulmonary embolism in a tetraplegic patient. The occurrence of pharyngoesophageal perforation after cervical spine surgery can be disastrous. It can be avoided by increasing surgeon awareness during the surgical procedure. Early detection, immediate and multidisciplinary therapy are recommended to achieve the best outcomes.展开更多
We describe a procedure of slide pharyngo-esophagoplasty for restoration following ablation of hypopharyngeal cancer in a 99 year-old man. The elderly presented to our hospital with 2-month dysphagia, occasional blood...We describe a procedure of slide pharyngo-esophagoplasty for restoration following ablation of hypopharyngeal cancer in a 99 year-old man. The elderly presented to our hospital with 2-month dysphagia, occasional bloody salivation, and 2-day respiratory distress. To solve the problems of swallowing difficulty and dyspnea, he underwent laryngopharyngectomy, permanent tracheostomy, and slide pharyngo-esophagoplasty. The patient was uneventful after the restoration procedure.展开更多
Background: Complete hypopharyngo-oesophageal occlusion is a rare complication of head and neck radiotherapy and a range of other conditions. Absolute dysphagia is accompanied by aspiration and dependence on gastrosto...Background: Complete hypopharyngo-oesophageal occlusion is a rare complication of head and neck radiotherapy and a range of other conditions. Absolute dysphagia is accompanied by aspiration and dependence on gastrostomy feeding. The condition presents a substantial management challenge. Surgical approaches to re-establish pharyngo-oesophageal continuity are varied, highly invasive and are associated with unpredictable outcomes. Minimally invasive techniques employing endoscopic and radiological techniques are emerging. This report describes a multidisciplinary approach which translates two interventional radiology techniques used in the management of central venous occlusions and biliary strictures to the management of three cases of complete hypopharyngo-oesophageal occlusion. Methods: Three cases with different underlying aetiologies had treatment initiated between 2009 and 2011. Antegrade pharyngoscopic access to the occlusions was accompanied by retrograde endoscopic access via a small gastrostomy. Luminal continuity was re-established by the interventional radiology technique of “sharp recanalisation” followed by passage of a wide bore nasogastric tube which was maintained in situ for 4-6 months, a duration of treatment analogous to that applied in the radiological management of fibrotic biliary strictures. After treatment a radiological contrast swallows examination was performed to gauge the calibre of the re-established lumen, assess functionality and to rule out aspiration. Results: Pharyngo-oesophageal continuity was re-established in all three cases on the first attempt. No complications occurred as a result of the procedures. In two cases, the excellent swallowing function was re-established, although one of these required prolonged post-treatment adjuvant interventions. In one case no swallowing function resulted, despite apparently successful re-establishment of luminal continuity. Conclusions: Complete fibrotic occlusion of the hypopharyngo-oesophageal lumen is rare and presents a substantial management challenge. A minimally invasive treatment combining antegrade radiological and retrograde endoscopic approaches resulted in successful re-establishment of luminal continuity in three cases of complete fibrotic occlusion of the hypopharyngo-oesophageal lumen. However variable responses to treatment suggest that both the underlying aetiology and the chronicity of the occlusion may influence the likelihood of a successful functional outcome. Until definitive management guidelines are established, we suggest that such cases are managed only by motivated multidisciplinary teams keen to develop their expertise in this area.展开更多
目的:分析蒲地蓝消炎口服液治疗小儿咽结膜热的疗效与依从性。方法:将257例咽结膜热的患儿随机分为治疗组与对照组,两组患儿均给予退热等对症处理。治疗组予以蒲地蓝消炎口服液每次5~10 m L口服,3次/天;对照组予以更昔洛韦注射液5 mg/(k...目的:分析蒲地蓝消炎口服液治疗小儿咽结膜热的疗效与依从性。方法:将257例咽结膜热的患儿随机分为治疗组与对照组,两组患儿均给予退热等对症处理。治疗组予以蒲地蓝消炎口服液每次5~10 m L口服,3次/天;对照组予以更昔洛韦注射液5 mg/(kg·d)静脉滴注,两组患儿均5 d为1个疗程。结果:治疗组总有效率92.6%(112/121),对照组总有效率93.4%(127/136),两组比较差异无统计学意义(P>0.05),治疗组的治疗依从性比对照组高(P<0.01)。结论:蒲地蓝消炎口服液治疗小儿咽结膜热疗效肯定,与更昔洛韦相比较疗效相当,但蒲地蓝消炎口服液服药依从性好,小儿与家长更易接受,值得临床推广应用。展开更多
文摘Anterior cervical spine surgery for traumatic or degenerative disease is a well-established procedure. However, complications such as pharyngoesophageal perforation can occur. In this study, we report a series of 6 pharyngoesophageal perforations after surgery. Based on the literature review, we analyzed pathogenesis, diagnosis and discussed therapeutic strategies. Three cases occurred after surgeries of traumatic cervical spine whereas the remaining were after surgeries for degenerative cervical myelopathy. The mean duration of surgery was 210 minutes. The symptoms, appearing 48 hours after surgery, were commonly hyperthermia, dysphagia, sore throat and swelling of the incision site. The diagnostic was confirmed after contrast-enhanced esophagography. The treatment strategies consisted of insertion of nasogastric feeding tube, oral intake restriction, intravenous antibiotics administration, wound drainage. Reoperation was necessary in 4 cases with removal of the hardware in three of them. One death occurred by pulmonary embolism in a tetraplegic patient. The occurrence of pharyngoesophageal perforation after cervical spine surgery can be disastrous. It can be avoided by increasing surgeon awareness during the surgical procedure. Early detection, immediate and multidisciplinary therapy are recommended to achieve the best outcomes.
文摘We describe a procedure of slide pharyngo-esophagoplasty for restoration following ablation of hypopharyngeal cancer in a 99 year-old man. The elderly presented to our hospital with 2-month dysphagia, occasional bloody salivation, and 2-day respiratory distress. To solve the problems of swallowing difficulty and dyspnea, he underwent laryngopharyngectomy, permanent tracheostomy, and slide pharyngo-esophagoplasty. The patient was uneventful after the restoration procedure.
文摘Background: Complete hypopharyngo-oesophageal occlusion is a rare complication of head and neck radiotherapy and a range of other conditions. Absolute dysphagia is accompanied by aspiration and dependence on gastrostomy feeding. The condition presents a substantial management challenge. Surgical approaches to re-establish pharyngo-oesophageal continuity are varied, highly invasive and are associated with unpredictable outcomes. Minimally invasive techniques employing endoscopic and radiological techniques are emerging. This report describes a multidisciplinary approach which translates two interventional radiology techniques used in the management of central venous occlusions and biliary strictures to the management of three cases of complete hypopharyngo-oesophageal occlusion. Methods: Three cases with different underlying aetiologies had treatment initiated between 2009 and 2011. Antegrade pharyngoscopic access to the occlusions was accompanied by retrograde endoscopic access via a small gastrostomy. Luminal continuity was re-established by the interventional radiology technique of “sharp recanalisation” followed by passage of a wide bore nasogastric tube which was maintained in situ for 4-6 months, a duration of treatment analogous to that applied in the radiological management of fibrotic biliary strictures. After treatment a radiological contrast swallows examination was performed to gauge the calibre of the re-established lumen, assess functionality and to rule out aspiration. Results: Pharyngo-oesophageal continuity was re-established in all three cases on the first attempt. No complications occurred as a result of the procedures. In two cases, the excellent swallowing function was re-established, although one of these required prolonged post-treatment adjuvant interventions. In one case no swallowing function resulted, despite apparently successful re-establishment of luminal continuity. Conclusions: Complete fibrotic occlusion of the hypopharyngo-oesophageal lumen is rare and presents a substantial management challenge. A minimally invasive treatment combining antegrade radiological and retrograde endoscopic approaches resulted in successful re-establishment of luminal continuity in three cases of complete fibrotic occlusion of the hypopharyngo-oesophageal lumen. However variable responses to treatment suggest that both the underlying aetiology and the chronicity of the occlusion may influence the likelihood of a successful functional outcome. Until definitive management guidelines are established, we suggest that such cases are managed only by motivated multidisciplinary teams keen to develop their expertise in this area.
文摘目的:分析蒲地蓝消炎口服液治疗小儿咽结膜热的疗效与依从性。方法:将257例咽结膜热的患儿随机分为治疗组与对照组,两组患儿均给予退热等对症处理。治疗组予以蒲地蓝消炎口服液每次5~10 m L口服,3次/天;对照组予以更昔洛韦注射液5 mg/(kg·d)静脉滴注,两组患儿均5 d为1个疗程。结果:治疗组总有效率92.6%(112/121),对照组总有效率93.4%(127/136),两组比较差异无统计学意义(P>0.05),治疗组的治疗依从性比对照组高(P<0.01)。结论:蒲地蓝消炎口服液治疗小儿咽结膜热疗效肯定,与更昔洛韦相比较疗效相当,但蒲地蓝消炎口服液服药依从性好,小儿与家长更易接受,值得临床推广应用。
