食管异物致穿孔并发致死性大出血治疗的研究  

Treatment of esophageal perforation complicated with lethal massive hemorrhage induced by foreign body

作　　者：胡鹏[1] 李友忠[1] 汪芹[1] 赖若沙[1] 杨新明[1] 朱纲华[1] 

机构地区：[1]中南大学湘雅二医院耳鼻咽喉科,长沙410011

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第9期597-600,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:总结分析食管异物致食管穿孔并发颈动脉或主动脉大出血的临床特点和治疗方法。方法:回顾性分析47例食管异物导致颈动脉和主动脉大出血患者的治疗经过,对异物类型、手术进路及方法和术后处理等进行总结。结果:24例颈段食管异物伴颈动脉大出血者,经食管镜或颈侧切开取出异物后,经颈部切口对动脉瘘口进行修补止血,19例治愈。23例胸段食管异物伴主动脉大出血者,均行开胸手术取异物,并对主动脉瘘口进行修复后,成功抢救3例,死亡20例。结论:对食管异物致食管穿孔损伤颈部动脉或主动脉者,最安全的治疗方式是经颈侧切开或开胸取出异物并进行血管修补和食管修复。对复发性颈总动脉出血者需行动脉结扎。对伴纵隔炎的患者,主动脉瘘口修复后,最好采用食管旷置以控制感染促进穿孔愈合。Objective：To explore the clinical characteristics and therapies for esophageal perforation complicated with lethal massive hemorrhage caused by esophageal foreign body. Method：To retrospective analysis the treatment of massive hemorrhage at the carotid artery or aorta caused by esophageal foreign body in forty seven patients, Foreign body characters, surgical approaches, and postsurgical management were summarized. Result： Among 24 patients with cervical esophageal foreign body, the object was removed either by esophagoscopy or through lateral cervical incision. After controlling carotid artery hemorrhage and repairing Fistula of artery from cervical incision, 19 patients survived. For the 23 patients with thoracic esophageal foreign body accompanied with aorta hemorrhea, thoracotomy was performed to remove the foreign body and repair the aortic fistula. Only 3 of these 23 patients recovered from the emergent surgery, other 20 patients died. Conclusion： For the patients with esophageal foreign body inducing large vessel impingement, the most reliable therapeutic method is surgical repairing of arterial perforation and extraction of the foreign body via cervical or thoracic incision. Carotid ligation should be considered in patients with recurrent carotid hemorrhage. For the patient with mediastinitis, esophageal exclusion is recommended to prevent infection and to promote healing of aortic perforation after aortic fistula repairing.

关 键 词：食管 异物 颈动脉 主动脉 并发症 

分 类 号：R768.3[医药卫生—耳鼻咽喉科]