食管异物合并严重并发症的临床治疗分析

目的 探讨食管异物合并严重并发症的治疗方法。方法 回顾性分析解放军总医院第一医学中心耳鼻咽喉头颈外科2014年7月-2018年7月收治的23例合并食管穿孔、颈胸部感染等严重并发症的食管异物患者的临床资料,其中男11例、女12例,年龄2~87岁,病程2～11 d。术前CT扫描评估异物位置、食管损伤及周围炎症情况,其中异物位于第一狭窄16例、第二狭窄4例、第三狭窄1例及第四狭窄2例,合并食管穿孔23例、食管周围炎17例、食管周围脓肿3例、颈部脓肿2例、纵隔脓肿1例。23例中,行经硬性食管镜异物取出术17例、颈侧切开探查异物取出术5例、开胸探查异物取出术1例,围手术期配合胃肠减压、抗感染、营养支持等综合措施治疗。术后根据Stooler分级标准评价食管损伤后食管狭窄程度。结果 本组23例均顺利完成手术;经手术及围手术期综合治疗,均顺利拔除鼻饲管,行颈侧切开和开胸探查的患者均顺利拔除伤口引流管,均痊愈出院。1例患者于术后1个月并发颈段食管狭窄Ⅱ级,行食管扩张治疗后恢复正常。患者出院后随访3～5个月,23例均正常进食普通饮食,标准食管狭窄程度Stooler分级均为0级。结论 伴有严重并发症的食管异物应依据异物嵌顿部位及患者临床表现采取不同的手术方法取出异物,同时给予围手术期胃肠减压、抗感染、营养支持等综合治疗措施,多学科联合施救是挽救患者生命的重要举措。

Study on clinical treatment of severe complications caused by esophageal foreign bodies

Objective This study aimed to investigate the treatment strategy of severe complications caused by esophageal foreign bodies.Methods A retrospective analysis was conducted on 23 patients with esophageal foreign body and severe complications, such as esophageal perforation and cervical and chest infections, admitted to the Department of Otolaryngology Head and Neck Surgery of the First Medical Center of People's Liberation Army General Hospital from July 2014 to July 2018. Among the patients, 11 were male and 12 were female, respectively aged from 2 years to 87 years. Among the 23 patients, foreign bodies were located in 16 cases of first esophageal stenosis, four cases of second esophageal stenosis, one case of third stenosis, and two cases of fourth stenosis. The patients in this group were evaluated for the location of foreign bodies, esophageal injury, and peripheral inflammation through preoperative computed tomography scans. Seventeen patients underwent rigid esophageal endoscopic foreign body removal, five patients underwent cervical incision to detect foreign body removal, and one patient underwent open chest exploration for foreign body removal. All patients were treated with comprehensive measures, such as gastrointestinal decompression, anti-infection, and nutritional support.Results All patients in this group successfully completed the operation, and the nasogastric feeding tube was successfully removed after operation and perioperative comprehensive treatment. The wound drainage tube was successfully removed in the patients who underwent lateral cervical incision and thoracotomy. All patients recovered and were discharged from the hospital. One patient experienced concurrent neck segment esophageal stenosis level two after 1-month postsurgery, and line expansion esophagus returned to normal after treatment. After discharge, the patients were followed up for 3-5 months. All the 23 patients received normal diet and exhibited grade 0 esophageal stenosis in accordance with stool classification standard.Conclusions Esophageal foreign bodies with severe complications should be removed in different means. Comprehensive treatment measures, such as perioperative gastrointestinal decompression, anti-infection, and nutritional support are essential. Multidisciplinary rescue is an important measure to save patients' lives.