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| ZHANG Baoliang,TANG Zhaoyang,XIAO Dongmin.Early debridement and vacuum sealing drainage followed by esophagus repairing for esophageal fistula due to anterior cervical surgery[J].Chinese Journal of Spine and Spinal Cord,2012,(11):994-998. |
| Early debridement and vacuum sealing drainage followed by esophagus repairing for esophageal fistula due to anterior cervical surgery |
| Received:July 27, 2012 Revised:September 11, 2012 |
| English Keywords:Esophageal fistula Anterior cervical surgery Debridement Vacuum sealing drainage Esophagus suture Effect |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the clinical outcome of early debridement and vacuum sealing drainage (VSD) followed by esophagus repairing for esophageal fistula due to anterior cervical surgery. Methods: From February 2006 to February 2012, 728 cases underwent anterior cervical spine surgery, 3 of them were complicated with esophageal fistula while the other 2 came from other hospitals. All the 5 cases were retrospectively reviewed. 4 of them developed to esophageal fistula five to nine days after anterior cervical surgery, and 1 case was noted 46 days later. Oral intake was prohibited and nasogastric tube was used for nutrition support after diagnose of esophageal fistula via esophagoscope. Intravenous broad-spectrum antibiotic therapy was utilized. The original surgical incision was used for debridement after preoperative preparation as soon as possible, and all sutures were removed. As for 1 case developing bone graft inflammatory and dissolved, the original instrument was removed and fixed by Halo-Frame after operation, while the internal fixation was kept in the other 4 cases. After complete debridement, the sponge was cut into suitable wedge-shape and placed in the wound and fixed by skin suture. The sponge was removed after 10 to 12 days drainage, then the second suture was performed to repair the esophagus perforation. For the patient suffering from delayed perforation, a piece of medical biological proteogel was used to cover the sutured perforation, auto illiac crest bone graft was performed and Halo-Frame was added. Drainage was used for 2 or 3 days and sutures were removed at 9 to 12 days after operation. Results: 4 patients had wound healed after second debridement, and the delayed esophageal fistula still had a few light yellow transparent secretion even after sutures were removed, and one week later scar tissue developed after conventional dressing changed. The patient with delayed esophagus fistula died at home one month later, and the cause of death was unknown, however the wound healed even at the time of death. The 4 alive cases were followed up for 6 months to 6 years. All 4 patients achieved good wound healing, no infection recurrence and the symptom of dysphagia or cervical pain were noted. Conclusions: Early debridement and vacuum sealing drainage followed by esophagus repairing is effective for esophageal fistula due to anterior cervical surgery. |
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