颈长肌在梨状窝穿孔修补术中的应用  

Application of longus colli muscle flap in the repair of pyriform sinus perforation

作　　者：程庆[1] 刘邦华[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院耳鼻咽喉头颈外科,武汉430022

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第12期975-978,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 探讨颈长肌在梨状窝穿孔修补术中的应用,提供一种新的食管穿孔修补材料.方法 回顾性分析2003-2013年8例经保守治疗无效的梨状窝穿孔患者临床资料.其中男5例,女3例;年龄45～68岁,中位数51岁.5例为食管镜术后,2例为麻醉插管引起,1例为吞异物自虐引起.病程在7天～8个月,中位数1个月.所有患者均伴有明显的颈部疼痛和吞咽痛,均出现并发症,其中高热5例次,皮下气肿或纵隔气肿5例次,3例合并上纵隔脓肿.均采用颈长肌修补术,在食管后壁和颈椎前壁之间游离并切取部分颈长肌形成肌肉瓣修补穿孑孔.结果 8例梨状窝穿孑孔患者手术修补均成功.均未发生术后感染、高热等并发症,所有患者在术后2周拔除鼻胃管并给予流质饮食,其中3例进食时出现呛咳,均在1周到半个月内恢复正常.3例并发上纵隔脓肿患者及1例梨状窝-纵隔-胸膜瘘患者术中同时行引流术等综合治疗后痊愈.随访半年至10年,无1例复发或发生食管狭窄.结论 梨状窝穿孔易发生严重的并发症,一旦确诊且伴有并发症者应立即行瘘口修补术.颈长肌容易辨认,取材方便,疗效满意,是梨状窝穿孔手术修补的理想材料.Objective To investigate the result of repair of pyriform sinus perforation using longus colli muscle flap and to provide a new material of esophageal perforation repair.Methods A retrospective clinical analysis was conducted on eight cases with pyriform sinus perforation from 2003-2013.Of the patients,5 were males and 3 females,aged 45 to 68 years with a median age of 51 years.The causes included the esophagoscopy surgery （5 cases）,anesthesia intubation （2 cases） and one case of swallowing foreign body.The duration were from seven days to 8 months,with a median duration of one month.All patients were associated with significant neck pain and swallowing pain.The complications were happened in all cases,including high fever in 5 cases,subcutaneous emphysema or mediastinal emphysema in 5 cases,and mediastinal abscess in 3 cases.The longus colli muscle flap was used to repair the perforation.Results The success rate of surgical repair was 100％ in all 8 cases.No recurrence or esophageal stricture occured during the follow-up of six months to 10 years.Three cases complicated by mediastinal abscess and 1 case by piriform sinus-mediastinum-pleural fistula,which cured after combined treatment.Conclusions Traumatic pyriform sinus perforation may cause serious complications.Early surgical repair is needed.The longus colli muscle flap is an ideal material for the repair of pyriform sinus perforation.

关 键 词：下咽 食管穿孔 外科皮瓣 

分 类 号：R655.4[医药卫生—外科学]