为了报告诊断,手术治疗,17例颈椎前路(ACS)手术后咽食管穿孔(PEPs)的术后处理。
回顾性多中心病例系列患者在ACS手术后接受PEP手术治疗。有关颈椎病理和手术的数据,合并症,PEP的诊断和外科治疗,气道管理,抗生素治疗,术后病程,收集出院时修复手术和最后一次随访后的喂养途径。
17名患者被纳入研究,共22例PEP修复手术。七个PEP(41%)发病早,而10(59%)延迟。所有患者通过前血管前后内脏宫颈切开术进行PEP手术修复,由穿孔的多层缝线组成,皮瓣插入。尽管这些患者的管理具有挑战性,我们系列的17名患者中有16名恢复了口服喂养。
PEP是颈椎手术中最可怕的并发症之一。由于它们的稀有性和异质性,标准化管理很难定义。根据我们对文献中最大案例系列的经验,建议采用多学科方法来处理这些患者.
To report about the diagnosis, surgical treatment, and postoperative management of pharyngo-esophageal perforations (PEPs) after anterior cervical spine (ACS) surgery in 17 patients.
A retrospective multicenter case series of patients surgically treated for PEP after ACS surgery was performed. Data regarding cervical spine pathology and surgery, comorbidities, diagnosis and surgical management of PEP, airway management, antibiotic therapy, postoperative course, and feeding route after repair surgery at discharge and last follow-up were collected.
Seventeen patients were included in the study, for a total of 22 surgical procedures for PEP repair. Seven PEPs (41%) had early onset, whereas 10 (59%) were delayed. All patients underwent PEP surgical repair through an anterior prevascular retrovisceral cervicotomic approach, consisting of multiple layer sutures of the perforation, with flap interposition. Despite the challenging management of these patients, 16 of 17 patients from our series restored oral feeding.
PEPs are among the most appalling complications of cervical spine surgery. Because of their rarity and heterogeneous presentation, a standardized management is difficult to define. From our experience with the largest case series in the literature, a multidisciplinary approach is advisable to deal with these patients.