颈椎前路手术并发食道瘘的诊断与治疗

目的探讨颈椎前路手术并发食道瘘的原因、诊断、治疗及预防。方法对1985～2003年诊治的13例因行颈前路手术出现食道瘘的病例进行分析。结果颈椎前路手术后食道瘘的发生原因：(1)术中拉钩长时间压迫食道,致牵拉处食道缺血坏死6例;(2)颈椎内固定物松动脱落致损伤食道3例;(3)颈椎植骨块松动脱落,致食道损伤2例;(4)手术中器械直接损伤食道1例;(5)手术中颈椎内固定物将食道嵌入,致食道损伤1例。诊断：术后出现高热、咽部疼痛、伤口肿胀、进食时伤口内有食物残渣或液体流出等,即考虑食道瘘的发生。行食道造影可明确诊断。治疗：禁食、水,下胃管;拆除切口缝线,敞开切口引流,换药;待伤口炎症反应消退,行食道修补术。结论颈椎前路手术致食道瘘的发生原因较多,应采取措施预防其发生,并采取正确的治疗方法处理已经出现的食道瘘,总体来说,其治疗效果良好。

Diagnosis and treatment of esophageal fistula in anterior cervical spine surgery

Objective To evaluate the causes, diagnosis, treatment and prevention of esophagocutaneous fistula in anterior cervical spine surgery. Methods Thirteen cases with esophagocutaneous fistula in anterior cervical spine surgery were studied. Results The causes includes: (1)During the operation,esophagus was oppressed by a clasp for so long time that made a pressure necrosis of the esophagus; (2)Esophagus was injuried by loosed plates and screws; (3)Loosed bone grafts oppressed esophagus; (4)Esophagus was injuried by operative appliance in the operation; (5) Esophagus was oppressed by the plate. Diagnosis: After anterior cervical spine surgery if patients had a high fever, sore throat, swelling incision, and food sediment was found in the incision, esophagocutaneous fistula should be considered. The final diagnosis could be done by esophageal radiography. Treatment: Fasting cure, nasogastric tube and wound drainage should be used; When the inflammation ended, patients should undergo operation of closure of the esopheageal fistula. Conclusions The esophagocutaneous fistula in anterior cervical spine surgery has several causes mentioned above. We should take precautionary measures to avoid the complication, and use appropriate treatment to cure when it happens.