尖锐食管异物致颈部游走性异物的诊治体会  

Diagnosis and treatment of cervical migratory foreign bodies caused by sharp esophageal foreign bodies

作　　者：刘磊峰 邱海涛 江枫 陈立航 李飞 姚俊 LIU Leifeng;QIU Haitao;JIANG Feng;CHEN Lihang;LI Fei;YAO Jun(Department of Otolaryngology Head and Neck Surgery,Affiliated Hospital of Guangdong Medical University,Zhanjiang,524001,China;Department of Radiology,Affiliated Hospital of Guangdong Medical University)

机构地区：[1]广东医科大学附属医院耳鼻咽喉头颈外科,广东湛江524001 [2]广东医科大学附属医院放射科

出　　处：《临床耳鼻咽喉头颈外科杂志》2019年第11期1068-1071,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨尖锐食管异物穿透食管壁,形成颈部游走性异物的临床表现、影像学表现及治疗方法。方法:9例患者均为异物史明确,消化道造影或胃镜检查未发现食管内异物,经颈部CT检查后发现异物已游走于食管外颈部软组织内,8例患者成功取出异物,1例术中未发现明确异物。结果:9例患者中,8例患者成功取出异物未出现咽瘘等并发症。1例患者术中未发现明确异物,术后出现气管食管瘘,带胃管出院。结论:对于有明确异物史的患者,消化道造影或胃镜检查有可能表现为阴性,应及时行颈部或胸部增强CT检查,排除食管外异物。CT检查尤其是增强扫描对于食管外游走性异物的诊断及定位至关重要,同时可以准确的判断异物与重要组织及血管间的关系,对于异物成功取出及降低并发症产生具有指导性意义。Objective: Imaging findings and treatment of sharp foreign bodies penetrating the esophagus to migrate in the neck were collected. Method: All of 9 cases were determined by CT imaging. The foreign bodies were removed in 8 cases through the lateral cervical approach. The last case was taken out by bronchoscope. Eight cases successfully removed the foreign bodies. No definite foreign body was found in 1 case. Result: There were no postoperative complications in 8 patients that successful removed of foreign bodies. All patients begin to eat normally after operation and were discharged from hospital in 7 days. Tracheoesophageal fistula occurred that happened to the patient that no foreign body was found in operation. So gastric tube was retained for 7 days. Conclusion: CT imaging should be performed to determine whether there is the possibility of foreign body penetrating out of the esophagus, for the patients who had explicit history but the foreignbodies could not be found by barium meal examination. If necessary, three-dimensional CT reconstruction of the neck should be performed to locate the foreign body. Surgical exploration should be done as soon as possible to avoid aimless migration of foreign bodies, and it is difficult to find it during operation.

关 键 词：食管穿孔 颈部异物 诊断 治疗 

分 类 号：R765[医药卫生—耳鼻咽喉科]