外科手术治疗食管异物研究
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摘要
目的探讨外科手术对食管异物的治疗效果及价值。方法回顾性分析我科在2012年12月～2018年1月收治行外科手术治疗的21例食管异物患者的临床资料。结合术前临床症状、体征、影像学及内镜检查结果,准确定位异物位置,选择经颈或经胸行食管异物取出术,术后予以肠外及早期肠内营养支持、抗感染、抑酸治疗。结果 15例患者治愈出院,另6例转入当地医院继续营养支持、抑酸治疗后治愈,无一例死亡。术后出现并发症共8例(38.09%),颈部异物及胸段异物术后并发症分别为2例(9.52%)、6例(28.57%)。其中食管瘘2例(9.52%),1例经瘘口引流、营养支持、抗感染等保守治疗后治愈,1例行二次剖胸手术后治愈;术后声音嘶哑3例(14.29%),出院后随访1～2个月均恢复正常。随访7个月～5年,除1例因食管癌去世,余均无任何吞咽困难、进食哽噎感等症状,生活质量未受影响。结论外科手术为食管异物主要治疗方式之一,应及时和稳妥地取出异物。结合术前定位,术中行一期缝合食管或仅通畅引流方法可行,但需重视患者术后并发症及术后营养支持。
Objective To investigate the therapeutic effect and value of surgery on foreign body in esophagus. Methods The clinical data of 21 patients with foreign body in esophagus who underwent surgical treatment from December 2012 to January 2018 were retrospectively analyzed.Combined with preoperative clinical symptoms, signs, imaging and endoscopic findings, accurately locate foreign bodies, choose transesophageal or transthoracic foreign body in esophagus removal, postoperative parenteral and early enteral nutrition support, anti-infection, acid suppression treatment. Results 15 patients were cured and discharged. The other 6 patients were transferred to local hospitals for further nutritional support and acid suppression treatment. No deaths occurred. There were 8 cases(38.09%) with postoperative complications. The postoperative complications of cervical foreign body and thoracic foreign body were 2 cases(9.52%) and 6 cases(28.57%). Among them, 2 cases(9.52%) of esophageal fistula, 1 case were cured after conservative treatment such as mouth drainage, nutritional support, anti-infection, 1 case was cured after second thoracotomy,and 3 cases(14.29%) were postoperative hoarseness. All patients were followed up for 1 to 2 months after discharge and returned to normal. During the follow-up of 7 months to 5 years, except for one case of death due to esophageal cancer, the rest did not have any symptoms such as dysphagia,eating sensation, and the quality of life was not affected. Conclusion Surgical surgery is one of the main treatment methods for foreign body in esophagus. Foreign bodies should be removed in a timely and safe manner. In combination with preoperative positioning, intraoperative suture of the esophagus or only patency drainage is feasible, but attention should be paid to postoperative complications and postoperative nutritional support.
Objective To investigate the therapeutic effect and value of surgery on foreign body in esophagus. Methods The clinical data of 21 patients with foreign body in esophagus who underwent surgical treatment from December 2012 to January 2018 were retrospectively analyzed.Combined with preoperative clinical symptoms, signs, imaging and endoscopic findings, accurately locate foreign bodies, choose transesophageal or transthoracic foreign body in esophagus removal, postoperative parenteral and early enteral nutrition support, anti-infection, acid suppression treatment. Results 15 patients were cured and discharged. The other 6 patients were transferred to local hospitals for further nutritional support and acid suppression treatment. No deaths occurred. There were 8 cases(38.09%) with postoperative complications. The postoperative complications of cervical foreign body and thoracic foreign body were 2 cases(9.52%) and 6 cases(28.57%). Among them, 2 cases(9.52%) of esophageal fistula, 1 case were cured after conservative treatment such as mouth drainage, nutritional support, anti-infection, 1 case was cured after second thoracotomy,and 3 cases(14.29%) were postoperative hoarseness. All patients were followed up for 1 to 2 months after discharge and returned to normal. During the follow-up of 7 months to 5 years, except for one case of death due to esophageal cancer, the rest did not have any symptoms such as dysphagia,eating sensation, and the quality of life was not affected. Conclusion Surgical surgery is one of the main treatment methods for foreign body in esophagus. Foreign bodies should be removed in a timely and safe manner. In combination with preoperative positioning, intraoperative suture of the esophagus or only patency drainage is feasible, but attention should be paid to postoperative complications and postoperative nutritional support.
引文
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[8]Zhang X,Jiang Y,Fu T,et al.Esophageal foreign bodies in adults with different durations of time from ingestion to effectivetreatment[J].Journal of International Medical Research,2017,45(4):1386-1393.
[9]García-Compeán D,González-González JA,Duran-CastroJJ,et al.Low Prevalence of Biopsy-Proven EosinophilicEsophagitis in Patients with Esophageal Food Impaction inMexican Population[J].Digestive Diseases&Sciences,2018,63(6):1-7.
[10]Okumuo M,Ozkan F,Bozkurt S,et al.Arteria lusoria:a very rare cause of esophageal obstruction in a hypoxemic patient[J].Turkish Journal of Gastroenterology the Official Journal ofTurkish Society of Gastroenterology,2014,25(4):433-434.
[11]Han H,Pan M,Tao Y,et al.Early Enteral Nutrition is Associated with Faster Post-Esophagectomy Recovery in ChineseEsophageal Cancer Patients:A Retrospective Cohort Study[J].Nutrition&Cancer,2018,70(4):1.
[12]张德荣.食管癌术后颈部吻合口瘘不同途径营养支持[J].中华临床营养杂志,2018,1(3):156-159.
[2]PR Pfau.Removal and management of esophageal foreign bodies[J].Techniques in Gastrointestinal Endoscopy,2014,16(1):32-39.
[3]Pedro Magalh觔es-Costa,Liliana Carvalho,José Pedro Rodrigues,et al.Endoscopic Management of Foreign Bodies in theUpper Gastrointestinal Tract:An Evidence-Based Review Arti-cle[J].Ge Portuguese Journal of Gastroenterology,2016,23(3):142.
[4]Toma EA,Oun M,Enciu O,et al.The Surgical Management of Acute Esophageal Perforation by Accidentally Ingested FishBone[J].Chirurgia,2018,113(1):156
[5]Birk M,Bauerfeind P,Deprez P,et al.Removal of foreign bodies in the upper gastrointestinal tract in adults:European Societyof Gastrointestinal Endoscopy(ESGE)Clinical Guideline[J].En-doscopy,2016,48(5):489-496.
[6]Watanabe K,Amano M,Nakanome A,et al.The prolonged presence of a fish bone in the neck[J].Tohoku Journal of Ex-perimental Medicine,2012,227(1):49.
[7]时辉,沈春辉,梅龙勇.食管异物的外科治疗[J].中国胸心血管外科临床杂志,2011,18(4):329-331.
[8]Zhang X,Jiang Y,Fu T,et al.Esophageal foreign bodies in adults with different durations of time from ingestion to effectivetreatment[J].Journal of International Medical Research,2017,45(4):1386-1393.
[9]García-Compeán D,González-González JA,Duran-CastroJJ,et al.Low Prevalence of Biopsy-Proven EosinophilicEsophagitis in Patients with Esophageal Food Impaction inMexican Population[J].Digestive Diseases&Sciences,2018,63(6):1-7.
[10]Okumuo M,Ozkan F,Bozkurt S,et al.Arteria lusoria:a very rare cause of esophageal obstruction in a hypoxemic patient[J].Turkish Journal of Gastroenterology the Official Journal ofTurkish Society of Gastroenterology,2014,25(4):433-434.
[11]Han H,Pan M,Tao Y,et al.Early Enteral Nutrition is Associated with Faster Post-Esophagectomy Recovery in ChineseEsophageal Cancer Patients:A Retrospective Cohort Study[J].Nutrition&Cancer,2018,70(4):1.
[12]张德荣.食管癌术后颈部吻合口瘘不同途径营养支持[J].中华临床营养杂志,2018,1(3):156-159.