外科途径治疗经保守处理无效的食管异物_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

王超 ,  戴天阳 , 杨晓燕 , 韩飞 , 胡智 , 何开明

西南医科大学附属医院胸心外科（四川泸州 646000）;

Corresponding author：

戴天阳, Email: daitianyang12345@163.com

Keywords：

食管异物; 食管穿孔; 手术途径; 手术方法

DOI：

10.7507/1007-4848.201704024

Video：

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目的探讨保守治疗无效的食管异物经外科治疗的手术途径和方法，以减少手术对患者的损伤和术后并发症的发生、促进患者快速康复。方法回顾性分析 2011 年 6 月至 2016 年 8 月我院食管异物经保守治疗无效需外科手术治疗 37 例患者的临床资料，其中男 21 例、女 16 例，年龄 17～62（42.00±9.75）岁。8 例经颈部切口手术治疗，27 例经胸部切口取出异物，2 例经胸腔镜取出异物。结果随访 3～18（7.95±3.41）个月，4 例术后发生消化瘘患者在术后 2～5 个月能正常进食，其余患者均在术后 1 个月能正常进软质饮食，术后 1.5 个月正常饮食。2 例手术患者因术后纵隔感染、胸腔感染致脓毒血症，多器官功能衰竭死亡。结论食管异物的外科手术根据其嵌顿的位置不同、穿孔与否、手术路径及方法亦有所不同，采取适宜的手术途径和方法可以提高手术的准确性，减少手术对食管的损伤和术后并发症，减轻患者的痛苦，从而提高患者术后生存质量。

Citation： 王超, 戴天阳, 杨晓燕, 韩飞, 胡智, 何开明. 外科途径治疗经保守处理无效的食管异物. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(6): 539-542. doi: 10.7507/1007-4848.201704024 Copy

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2.	Aronberg RM, Punekar SR, Adam SI, et al. Esophageal perforation caused by edible foreign bodies: a systematic review of the literature. Laryngoscope, 2015, 125(2): 371-378.
3.	Akram J, Amin FM, Toft JG, et al. Treatment of foreign body impactions in oesophagus. Ugeskr Laeger, 2013, 175(10): 640-643.
4.	Sugawa C, Ono H, Taleb M, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract:A review.World J Gastrointest Endosc, 2014, 6(10): 475-481.
5.	Kim HU. Oroesophageal fish bone foreign body. Clin Endosc, 2016, 49(4): 318-326.
6.	Biancari F, D'Andrea V, Paone R, et al. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg, 2013, 37(5): 1051-1059.
7.	Ambe P, Weber SA, Schauer M, et al. Swallowed foreign bodies in adults.Dtsch Arztebl Int, 2012, 109(50): 869-875.
8.	Triadafilopoulos G, Roorda A, Akiyama J. Update on foreign bodies in the esophagus: diagnosis and management. Curr Gastroenterol Rep, 2013, 15(4): 317.
9.	王利利, 龚巍, 冯永, 等. 食管异物严重并发症临床分析. 中华耳鼻咽喉头颈外科杂志, 2015, 50(6): 507-510.
10.	彭利, 欧阳晖, 黄河, 等. 食管异物致穿孔并颈部脓肿的诊治. 临床耳鼻咽喉头颈外科杂志, 2016, 10(8): 653-654.
11.	Lee YJ, Park CR, Kim JW, et al. The hemoptysis and the subclavian artery pseudoaneurysm due to a fishbone injury: A case report. Medicine (Baltimore), 2015, 94(42): e1821.
12.	Tan S, Tan S, Peng M, et al. Management of an ingested fish bone in the lung using video-assist thoracic surgery: a case report. Medicine (Baltimore), 2015, 94(22): e943.
13.	何松林, 刘慧, 赵泽良. 带蒂大网膜预防食管癌术后胸内吻合口瘘的临床应用. 中外医学研究, 2016, 14(14): 42-44.
14.	Abu-Omar Y, Kocher GJ, Bosco P, et al. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg, 2017, 51(1): 10-29.
15.	Seo YD, Lin J, Chang AC, et al. Emergent esophagectomy for esophageal perforations: A safe option. Ann Thorac Surg, 2015, 100(3): 905-909.

1. Bekkerman M, Sachdev AH, Andrade J, et al. Endoscopic management of foreign bodies in the gastrointestinal tract: a review of the literature. Gastroenterol Res Pract, 2016, 2016: 8520767.
2. Aronberg RM, Punekar SR, Adam SI, et al. Esophageal perforation caused by edible foreign bodies: a systematic review of the literature. Laryngoscope, 2015, 125(2): 371-378.
3. Akram J, Amin FM, Toft JG, et al. Treatment of foreign body impactions in oesophagus. Ugeskr Laeger, 2013, 175(10): 640-643.
4. Sugawa C, Ono H, Taleb M, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract:A review.World J Gastrointest Endosc, 2014, 6(10): 475-481.
5. Kim HU. Oroesophageal fish bone foreign body. Clin Endosc, 2016, 49(4): 318-326.
6. Biancari F, D'Andrea V, Paone R, et al. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg, 2013, 37(5): 1051-1059.
7. Ambe P, Weber SA, Schauer M, et al. Swallowed foreign bodies in adults.Dtsch Arztebl Int, 2012, 109(50): 869-875.
8. Triadafilopoulos G, Roorda A, Akiyama J. Update on foreign bodies in the esophagus: diagnosis and management. Curr Gastroenterol Rep, 2013, 15(4): 317.
9. 王利利, 龚巍, 冯永, 等. 食管异物严重并发症临床分析. 中华耳鼻咽喉头颈外科杂志, 2015, 50(6): 507-510.
10. 彭利, 欧阳晖, 黄河, 等. 食管异物致穿孔并颈部脓肿的诊治. 临床耳鼻咽喉头颈外科杂志, 2016, 10(8): 653-654.
11. Lee YJ, Park CR, Kim JW, et al. The hemoptysis and the subclavian artery pseudoaneurysm due to a fishbone injury: A case report. Medicine (Baltimore), 2015, 94(42): e1821.
12. Tan S, Tan S, Peng M, et al. Management of an ingested fish bone in the lung using video-assist thoracic surgery: a case report. Medicine (Baltimore), 2015, 94(22): e943.
13. 何松林, 刘慧, 赵泽良. 带蒂大网膜预防食管癌术后胸内吻合口瘘的临床应用. 中外医学研究, 2016, 14(14): 42-44.
14. Abu-Omar Y, Kocher GJ, Bosco P, et al. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg, 2017, 51(1): 10-29.
15. Seo YD, Lin J, Chang AC, et al. Emergent esophagectomy for esophageal perforations: A safe option. Ann Thorac Surg, 2015, 100(3): 905-909.

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外科途径治疗经保守处理无效的食管异物

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