食管异物并发食管穿孔及颈部脓肿临床分析  

Clinical analysis of esophageal perforation and neck abscess induced by esophageal foreign body

作　　者：古庆家[1] 樊建刚[1] 李静娴[1] 何刚[1] 

机构地区：[1]四川省人民医院耳鼻咽喉科,成都610072

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第7期459-461,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨食管异物并发食管穿孔及颈部脓肿的临床特点及治疗方法,以期提高对该病的诊治水平。方法:24例食管异物并发食管穿孔及颈部脓肿患者均在全身麻醉下行食管镜检查异物取出术,其中经食管镜取出异物14例,开胸后取出义齿3例,颈侧切开取出异物5例;余2例未见异物。结果:24例患者中并发脓肿16例,其中食管周围脓肿10例,颈部脓肿4例,纵隔脓肿2例;治愈21例,死亡1例,1例因血糖高转内分泌科,1例转胸外科继续治疗。结论:早期诊断、早期治疗是处理食管异物并发食管穿孔的关键。对于食管异物并发食管穿孔及颈部脓肿患者行薄层CT扫描具有极高的诊断及鉴别诊断价值。颈部脓肿一经确诊,应及时行脓肿切开引流术,合理应用抗生素,有效控制感染及并发症的发生,加强营养支持治疗可提高治愈率。Objective：To investigate the diagnosis and treatment of esophageal perforation and neck abscess in- duced by esophageal foreign body and to make a better solution for the disease. Method：Twenty-four cases with e- sophageal perforation and neck abscess induced by esophageal foreign body treated in our department were surgery under general anesthesia. The foreign bodies were removed via esophagoscope in 14 cases, thoroeomy in 3,and lat- eral neck incision in 5 ;and no foreign bodies were found in 2 cases. Result：There were 16 cases complicated by ab- scess. Among these complications,there were 10 cases of periesopbageal abscess,4 cases of neck abscess and 1 case of mediastinal abscess. In 24 patients, 21 cases cured and one died. One case was sent to the department of endo- crinology because of hyperglycaemia and two cases were sent to the department of thoracic surgery for further treatment. Conclusion： Early diagnosis and treatment is the key to the management of esophageal perforation in- duced by esophageal foreign body. Thin-section CT has a high value for the diagnosis and differential diagnosis in such patients. Once deep neck abscess is diagnosed, an early abscess surgical drainage, an appropriate antibiotics and a nutrition supporting treatment are effective for the patients.

关 键 词：食管异物 穿孔 脓肿 引流 

分 类 号：R768.22[医药卫生—耳鼻咽喉科]