置管并负压引流治疗颈椎前路手术并发食管瘘  

Catheter rinsing and suction drainage for esophageal fistula caused by anterior cervical spine surgery

作　　者：马良[1] 朱松青[1] 邓强[2] 孟祥玉[1] 吐尔洪江.阿布都热西提 刘云涛[1] 

机构地区：[1]新疆医科大学第六附属医院微创脊柱外科治疗中心,新疆乌鲁木齐830002 [2]新疆医科大学第一附属医院

出　　处：《中国骨与关节损伤杂志》2016年第7期692-696,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨颈椎前路手术并发食管瘘的原因及预防措施,并观察置管冲洗负压引流治疗的效果。方法回顾性分析自2001-03—2014-10诊治的18例颈椎前路手术并发的食管瘘。3例行一期清创、瘘道口缝合,放置引流管引流。4例行一期清创、瘘道口部分缝合,伤口畅开呋喃西林纱条填塞。11例行一期清创、瘘道口缝合,放置冲洗管和负压引流管。结果 18例均获得随访2~36个月,平均12个月。一期清创、瘘道口缝合、负压引流11例中1例因瘘道口未愈合,反复感染,经长期换药20周窦道形成,随访36个月后窦道未完全愈合。将一期清创、瘘道口缝合、单纯引流和呋南西林纱条填塞治愈的7例定为换药组,将一期清创、瘘道口缝合、负压引流治愈的10例定为冲洗组。换药组食管瘘停止时间为（11.2±6.8）周,冲洗组为（4.2±4.9）周,冲洗组食管瘘停止时间明显早于换药组,差异有统计学意义（t=2.848,P〈0.05）。结论颈椎前路术后并发食管瘘治疗较棘手,在结合手术修补、全身支持治疗的同时,采用置管冲洗并负压引流的方法治疗可以取得较满意的疗效。Objective To investigate the causes and prevention of esophageal fistula（EF） caused by anterior cervical spine surgery（ACSS） and the treatment effect of catheter rinsing and suction drainage. Methods Retrospective analysis of EF caused by ACSS in 18 patients from March 2001 to October 2014 was conducted. For three patients, debridement at first time was performed, fistula was sutured and the drainage tube was placed. For four cases, debridement at first time was performed,part of the fistula was sutured, wounds were opened and nitrofurazone gauze was stuffed. For eleven cases, debridement at first time was performed, fistula was sutured, catheter and suction drainage tube were placed. Results All 18 cases were followed up for 2-36 months, average 12 months. One of 11 patients who underwent debridement at first time, fistula suture and suction drainage had repeated infection because fistula did not heal, fistula was formed by long-term dressing after 20 weeks,the fistula was not fully healed after 36 months followed up. Seven patients underwent debridement at first time, fistula suture,simple drainage and nitrofurazone gauze stuffing served as dressing group, while ten patients who were cured by debridement at first time, fistula suture and suction drainage as rinsing group. Esophageal fistula stopping time of dressing group was（11.2±6.8）weeks, and rinsing group was（4.2 ±4.9） weeks. Esophageal fistula stopping time of rinsing group was obviously earlier than which of dressing group. The difference was statistically significant（t =2.848, P〈0.05）. Conclusion Treatment of ACSS complicated by EF is difficult. Surgical repair with supportive therapy, catheter rinsing and suction drainage can get a satisfactory therapeutic effect for esophageal fistula caused by anterior cervical spine surgery.

关 键 词：颈椎前路手术 食管瘘 置管冲洗 负压引流 

分 类 号：R619[医药卫生—外科学]