早期清创闭合负压引流二期修复治疗颈椎前路术后并发食道瘘的疗效观察

Early debridement and vacuum sealing drainage followed by esophagus repairing for esophageal fistula due to anterior cervical surgery

中文关键词:  食道瘘  颈椎前路手术  清创术  闭合负压引流术  食道修补术  效果

英文关键词:Esophageal fistula  Anterior cervical surgery  Debridement  Vacuum sealing drainage  Esophagus suture  Effect

中文摘要:

  【摘要】 目的：观察早期清创闭合负压引流二期修复治疗颈椎前路手术后并发食道瘘的效果。方法：2006年2月~2012年2月我院收治颈椎前路手术后并发食道瘘患者5例，其中我院行颈椎前路手术728例中术后并发食道瘘3例，外院转入2例。4例术后5~9d出现食道瘘，1例术后46d出现。经食道镜确诊食道瘘后，立即放置胃管，改鼻饲营养支持，静脉使用广谱抗菌素，沿原手术切口进入，拆除所有缝线，行清创术。1例迟发性食道瘘患者术中发现植骨颗粒已经部分感染、溶解，取出内固定和植骨块，术后行Halo外固定架固定；其余4例内固定均予保留。彻底清创后，将负压引流泡沫修剪成合适大小楔形放置于切口内，缝合皮肤固定泡沫，用生物贴膜覆盖泡沫贴紧于切口周围皮肤上以保持切口内密闭状态，接负压引流持续冲洗10~12d后，拆除密闭负压引流装置，常规换药2~3d后行二期食道修补术，食道瘘口均使用可吸收线缝合；迟发性食道瘘者瘘口较大术中加用生物蛋白胶覆盖已修复的瘘口，并再次行自体髂骨植入，使用Halo外固定架固定。术后常规放置切口引流管2~3d，9~12d切口拆线。结果：4例患者食道修补术后颈部切口愈合良好；随访6个月~6年，原颈部切口瘢痕愈合，无吞咽困难与颈部疼痛，无迟发性感染出现。1例迟发性食道瘘患者食道修补术拆线后切口仍有少许淡黄色透明分泌物，常规换药后1周瘢痕愈合，出院后1个月在家中死亡，死因不明，死亡时颈部切口愈合良好。结论：早期清创闭合负压引流二期修复治疗颈椎前路术后并发食道瘘有效。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical outcome of early debridement and vacuum sealing drainage (VSD) followed by esophagus repairing for esophageal fistula due to anterior cervical surgery. Methods: From February 2006 to February 2012, 728 cases underwent anterior cervical spine surgery, 3 of them were complicated with esophageal fistula while the other 2 came from other hospitals. All the 5 cases were retrospectively reviewed. 4 of them developed to esophageal fistula five to nine days after anterior cervical surgery, and 1 case was noted 46 days later. Oral intake was prohibited and nasogastric tube was used for nutrition support after diagnose of esophageal fistula via esophagoscope. Intravenous broad-spectrum antibiotic therapy was utilized. The original surgical incision was used for debridement after preoperative preparation as soon as possible, and all sutures were removed. As for 1 case developing bone graft inflammatory and dissolved, the original instrument was removed and fixed by Halo-Frame after operation, while the internal fixation was kept in the other 4 cases. After complete debridement, the sponge was cut into suitable wedge-shape and placed in the wound and fixed by skin suture. The sponge was removed after 10 to 12 days drainage, then the second suture was performed to repair the esophagus perforation. For the patient suffering from delayed perforation, a piece of medical biological proteogel was used to cover the sutured perforation, auto illiac crest bone graft was performed and Halo-Frame was added. Drainage was used for 2 or 3 days and sutures were removed at 9 to 12 days after operation. Results: 4 patients had wound healed after second debridement, and the delayed esophageal fistula still had a few light yellow transparent secretion even after sutures were removed, and one week later scar tissue developed after conventional dressing changed. The patient with delayed esophagus fistula died at home one month later, and the cause of death was unknown, however the wound healed even at the time of death. The 4 alive cases were followed up for 6 months to 6 years. All 4 patients achieved good wound healing, no infection recurrence and the symptom of dysphagia or cervical pain were noted. Conclusions: Early debridement and vacuum sealing drainage followed by esophagus repairing is effective for esophageal fistula due to anterior cervical surgery.