■报告我们在颈椎前路手术导致的食管穿孔治疗方面的最新经验,并比较两种伤口处理方法。
■这是对颈椎前路手术(2007-2020)导致食道穿孔的患者进行的回顾性审查。我们基于2种伤口管理方法检查结果:闭合(引流管上的闭合切口)与开放(通过次要意图使其开放以治愈)。我们收集了人口统计数据,操作管理,解决(恢复口服),时间到决议,解决所需的程序数量,微生物学,逗留时间,和颈部发病率。
■共纳入13例患者(10例男性)。中位年龄为52岁(范围,24-74岁)。所有患者均行手术引流,修复,或者试图修复穿孔,硬件拆卸,建立肠内通路。伤口进行了封闭与开放管理(6个封闭,7开放)。术后早期因急性呼吸窘迫综合征和误吸死亡2例(开放组),1例患者失访(封闭组)。在其余10名患者中:分辨率为80%对100%,30天内的分辨率为20%对100%,解决所需的手术次数中位数为3对1,住院时间中位数为23对14天,对于封闭和开放的团体,分别。
■颈椎前路手术后的食管穿孔应采用外科颈引流的多学科方式进行处理,在可行的情况下进行初步修复,硬件拆卸,建立肠内通路。我们提倡开放式颈部伤口处理,以减少解决时间,程序的数量,和逗留时间的长短。
UNASSIGNED: To report our updated experience in the management of esophageal perforation resulting from anterior cervical spine surgery, and to compare two wound management approaches.
UNASSIGNED: This is a retrospective review of patients managed for esophageal perforations resulting from anterior cervical spine surgery (2007-2020). We examine outcomes based on 2 wound management approaches: closed (closed incision over a drain) versus open (left open to heal by secondary intention). We collected data on demographics, operative management, resolution (resumption of oral intake), time to resolution, number of procedures needed for resolution, microbiology, length of stay, and neck morbidity.
UNASSIGNED: A total of 13 patients were included (10 men). Median age was 52 years (range, 24-74 years). All patients underwent surgical drainage, repair, or attempted repair of perforation, hardware removal, and establishment of enteral access. Wounds were managed closed versus open (6 closed, 7 open). There were 2 early postoperative deaths due to acute respiratory distress syndrome and aspiration (open group), and 1 patient was lost to follow-up (closed group). Among the remaining 10 patients: resolution rate was 80% versus 100%, resolution in 30 days was 20% versus 100%, median number of procedures needed for resolution was 3 versus 1, and median hospital stay was 23 versus 14 days, for the closed and open groups, respectively.
UNASSIGNED: Esophageal perforation following anterior cervical spine surgery should be managed in a multidisciplinary fashion with surgical neck drainage, primary repair when feasible, hardware removal, and establishment of enteral access. We advocate open neck wound management to decrease the time-to-resolution, number of procedures, and length of stay.