中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2014年
12期
975-978
,共4页
下咽%食管穿孔%外科皮瓣
下嚥%食管穿孔%外科皮瓣
하인%식관천공%외과피판
Hypopharynx%Esophageal perforation%Surgical flaps
目的 探讨颈长肌在梨状窝穿孔修补术中的应用,提供一种新的食管穿孔修补材料.方法 回顾性分析2003-2013年8例经保守治疗无效的梨状窝穿孔患者临床资料.其中男5例,女3例;年龄45～68岁,中位数51岁.5例为食管镜术后,2例为麻醉插管引起,1例为吞异物自虐引起.病程在7天～8个月,中位数1个月.所有患者均伴有明显的颈部疼痛和吞咽痛,均出现并发症,其中高热5例次,皮下气肿或纵隔气肿5例次,3例合并上纵隔脓肿.均采用颈长肌修补术,在食管后壁和颈椎前壁之间游离并切取部分颈长肌形成肌肉瓣修补穿孑孔.结果 8例梨状窝穿孑孔患者手术修补均成功.均未发生术后感染、高热等并发症,所有患者在术后2周拔除鼻胃管并给予流质饮食,其中3例进食时出现呛咳,均在1周到半个月内恢复正常.3例并发上纵隔脓肿患者及1例梨状窝-纵隔-胸膜瘘患者术中同时行引流术等综合治疗后痊愈.随访半年至10年,无1例复发或发生食管狭窄.结论 梨状窝穿孔易发生严重的并发症,一旦确诊且伴有并发症者应立即行瘘口修补术.颈长肌容易辨认,取材方便,疗效满意,是梨状窝穿孔手术修补的理想材料.
目的 探討頸長肌在梨狀窩穿孔脩補術中的應用,提供一種新的食管穿孔脩補材料.方法 迴顧性分析2003-2013年8例經保守治療無效的梨狀窩穿孔患者臨床資料.其中男5例,女3例;年齡45～68歲,中位數51歲.5例為食管鏡術後,2例為痳醉插管引起,1例為吞異物自虐引起.病程在7天～8箇月,中位數1箇月.所有患者均伴有明顯的頸部疼痛和吞嚥痛,均齣現併髮癥,其中高熱5例次,皮下氣腫或縱隔氣腫5例次,3例閤併上縱隔膿腫.均採用頸長肌脩補術,在食管後壁和頸椎前壁之間遊離併切取部分頸長肌形成肌肉瓣脩補穿孑孔.結果 8例梨狀窩穿孑孔患者手術脩補均成功.均未髮生術後感染、高熱等併髮癥,所有患者在術後2週拔除鼻胃管併給予流質飲食,其中3例進食時齣現嗆咳,均在1週到半箇月內恢複正常.3例併髮上縱隔膿腫患者及1例梨狀窩-縱隔-胸膜瘺患者術中同時行引流術等綜閤治療後痊愈.隨訪半年至10年,無1例複髮或髮生食管狹窄.結論 梨狀窩穿孔易髮生嚴重的併髮癥,一旦確診且伴有併髮癥者應立即行瘺口脩補術.頸長肌容易辨認,取材方便,療效滿意,是梨狀窩穿孔手術脩補的理想材料.
목적 탐토경장기재리상와천공수보술중적응용,제공일충신적식관천공수보재료.방법 회고성분석2003-2013년8례경보수치료무효적리상와천공환자림상자료.기중남5례,녀3례;년령45～68세,중위수51세.5례위식관경술후,2례위마취삽관인기,1례위탄이물자학인기.병정재7천～8개월,중위수1개월.소유환자균반유명현적경부동통화탄인통,균출현병발증,기중고열5례차,피하기종혹종격기종5례차,3례합병상종격농종.균채용경장기수보술,재식관후벽화경추전벽지간유리병절취부분경장기형성기육판수보천혈공.결과 8례리상와천혈공환자수술수보균성공.균미발생술후감염、고열등병발증,소유환자재술후2주발제비위관병급여류질음식,기중3례진식시출현창해,균재1주도반개월내회복정상.3례병발상종격농종환자급1례리상와-종격-흉막루환자술중동시행인류술등종합치료후전유.수방반년지10년,무1례복발혹발생식관협착.결론 리상와천공역발생엄중적병발증,일단학진차반유병발증자응립즉행루구수보술.경장기용역변인,취재방편,료효만의,시리상와천공수술수보적이상재료.
Objective To investigate the result of repair of pyriform sinus perforation using longus colli muscle flap and to provide a new material of esophageal perforation repair.Methods A retrospective clinical analysis was conducted on eight cases with pyriform sinus perforation from 2003-2013.Of the patients,5 were males and 3 females,aged 45 to 68 years with a median age of 51 years.The causes included the esophagoscopy surgery (5 cases),anesthesia intubation (2 cases) and one case of swallowing foreign body.The duration were from seven days to 8 months,with a median duration of one month.All patients were associated with significant neck pain and swallowing pain.The complications were happened in all cases,including high fever in 5 cases,subcutaneous emphysema or mediastinal emphysema in 5 cases,and mediastinal abscess in 3 cases.The longus colli muscle flap was used to repair the perforation.Results The success rate of surgical repair was 100％ in all 8 cases.No recurrence or esophageal stricture occured during the follow-up of six months to 10 years.Three cases complicated by mediastinal abscess and 1 case by piriform sinus-mediastinum-pleural fistula,which cured after combined treatment.Conclusions Traumatic pyriform sinus perforation may cause serious complications.Early surgical repair is needed.The longus colli muscle flap is an ideal material for the repair of pyriform sinus perforation.
