食管异物致穿孔并发致死性大出血治疗的研究

发布时间：2018-05-27 17:40

本文选题：食管 + 异物　；参考：《临床耳鼻咽喉头颈外科杂志》2014年09期

【摘要】：目的:总结分析食管异物致食管穿孔并发颈动脉或主动脉大出血的临床特点和治疗方法。方法:回顾性分析47例食管异物导致颈动脉和主动脉大出血患者的治疗经过,对异物类型、手术进路及方法和术后处理等进行总结。结果:24例颈段食管异物伴颈动脉大出血者,经食管镜或颈侧切开取出异物后,经颈部切口对动脉瘘口进行修补止血,19例治愈。23例胸段食管异物伴主动脉大出血者,均行开胸手术取异物,并对主动脉瘘口进行修复后,成功抢救3例,死亡20例。结论:对食管异物致食管穿孔损伤颈部动脉或主动脉者,最安全的治疗方式是经颈侧切开或开胸取出异物并进行血管修补和食管修复。对复发性颈总动脉出血者需行动脉结扎。对伴纵隔炎的患者,主动脉瘘口修复后,最好采用食管旷置以控制感染促进穿孔愈合。
[Abstract]:Objective: to summarize the clinical features and treatment of esophageal perforation complicated with carotid or aortic hemorrhage caused by esophageal foreign bodies. Methods: 47 cases of carotid and aortic massive hemorrhage caused by esophageal foreign bodies were analyzed retrospectively. The types of foreign bodies, operative approaches and methods, and postoperative management were summarized. Results Twenty four cases of cervical esophageal foreign body with massive bleeding of carotid artery were removed by esophagoscope or lateral incision of the neck. 19 cases of thoracic esophageal foreign body with massive aortic hemorrhage were cured by cervical incision repair hemostasis, and 23 cases of thoracic esophageal foreign body with massive aortic hemorrhage were cured. All patients underwent thoracotomy to get foreign bodies. After repairing aortic fistula, 3 cases were rescued successfully and 20 cases died. Conclusion: the safest treatment for esophageal perforation injury caused by esophageal foreign body is to remove the foreign body via cervical incision or thoracotomy and repair the esophagus. Artery ligation is necessary for recurrent common carotid artery hemorrhage. For patients with mediastinal inflammation, after repair of aortic fistula, esophageal open place should be used to control infection and promote perforation healing.
【作者单位】：中南大学湘雅二医院耳鼻咽喉科;
【分类号】：R768.3

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