Treatment of esophageal perforation after anterior cervical spine surgery

English Keywords:Esophageal perforation  Cervical surgery  Anterior

English Abstract:

  【Abstract】 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), including 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 cervical 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.