Retrospective analysis of 10 cases with esophageal fistula after anterior surgery for cervical spine fracture

作者全名："Du, Jinpeng; Gao, Xiangcheng; Hao, Dingjun; Quan, Zhengxue; Yan, Liang; He, Baorong"

作者地址："[Du, Jinpeng; Gao, Xiangcheng; Hao, Dingjun; Yan, Liang; He, Baorong] Xi An Jiao Tong Univ, Honghui Hosp, Dept Spine Surg, Friendship East Rd, Xian, Shaanxi, Peoples R China; [Quan, Zhengxue] Chongqing Med Univ, Dept Orthoped Surg, Affiliated Hosp 1, Chongqing, Peoples R China"

通信作者："Yan, L; He, BR (通讯作者)，Xi An Jiao Tong Univ, Honghui Hosp, Dept Spine Surg, Friendship East Rd, Xian, Shaanxi, Peoples R China."

来源：HELIYON

ESI学科分类：　

WOS号：WOS:001111609100001

JCR分区：Q1

影响因子：3.4

年份：2023

卷号：9

期号：11

开始页：　

结束页：　

文献类型：Article

关键词：Anterior surgery; Complication; Esophageal fistula; Spine fracture

摘要："Objective: This study aims to discuss the appropriate treatment of esophageal fistula following anterior surgery for cervical spine fracture. Methods: Clinical data of patients with cervical spine fracture treated at our research center from January 2000 to December 2019 were screened. Data of patients with esophageal fistula were included, and the causes of injury, diagnosis, and treatment were retrospectively analyzed. Results: A total of 3578 patients with cervical spine fracture were screened, among whom there were 10 cases (0.28 %) of esophageal fistula. 60 % of the cases were early-onset and all were caused by intraoperative electric knife injury. The positive rate of early endoscopy was only 25 %, while routine radiography showed a positive rate of 33.3 % after three attempts. Among the six patients with early-onset esophageal fistula, three underwent sternocleidomastoid flap transfer and two underwent primary suture, all achieving successful healing. In the four cases of late-onset esophageal fistula, two patients received implant removal, debridement, incision lavage, and sternocleidomastoid muscle flap transfer three weeks later. One patient received implant removal, debridement, vacuum sealing drainage, followed by sternocleidomastoid muscle pedicle transfer muscle flap plus lavage two weeks later and achieved complete recovery. All patients gargled alternately with metronidazole and chlorhexidine gargle after surgery. Conclusion: The occurrence of esophageal fistula is associated with surgical procedures, esophageal injury, and implant compression. Esophagography and endoscopy are the primary diagnostic methods, while incision exploration after ingestion of food mixed with methylene serves as a supplementary approach. Recommended treatments include alternating metronidazole and chlorhexidine gargles, esophageal rest, repair of the fistula, muscle flap packing, lavage and drainage, nutritional support, and removal of internal fixation if necessary. Post-surgery administration of antibiotics should continue until three consecutive lavage cultures yield negative results."

基金机构："Science and Technology Commission of Xi' an [21YXYG0024, 23YXYJ0083]; Science and Technology Association of Shaanxi [2021PSLK32]"

基金资助正文："This study was funded by the Project from the Science and Technology Commission of Xi' an (21YXYG0024, 23YXYJ0083) and Science and Technology Association of Shaanxi (2021PSLK32)."