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題 名 | Flexible Esophagoscopy in the Management of Acute Corrosive Esophageal Injury in Adults=軟氏食道鏡在成人急性食道腐蝕傷的處理 |
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作 者 | 郭華基; 蔣台舟; | 書刊名 | 臺灣外科醫學會雜誌 |
卷 期 | 39:3 民95.06-07 |
頁 次 | 頁133-138 |
分類號 | 416.216 |
關鍵詞 | 軟式食道鏡; 食道腐蝕傷; Flexible esophagoscopy; Assessment; Early operation; Corrosive injury; |
語 文 | 英文(English) |
中文摘要 | 軟式纖維性食道鏡檢查屬於侵入性檢查,可能發生醫源性臟器穿孔,而存有一點危險性,故此對於應用在上消化器急症腐蝕傷病患仍有爭議性;本文回顧軟式纖維性食道鏡檢查,因自殺吞嚥腐蝕液病例的圖像,和手術治療的結果,目的在評估軟式纖維性食道鏡檢查,對上消化道急症腐蝕傷的急性診療相關性。從1990年至2000年共收集有449例因自殺吞嚥腐蝕液病案,以成人為主且大部分吞服鹽酸,軟式纖維性食道鏡檢查所見上消化道腐蝕傷的圖像,依傷情嚴重度分為3級;病患若有下述情況,將安排緊急手術:包括3級食道灼傷、近端食道2級灼傷同時高度懷疑遠端消化道穿孔、上消化道因急症腐蝕傷出現持續出血,和有急性持續出現腹痛而未能配合接受食道鏡檢查的病患。在此449例腐蝕液病案中,符合前述病況需要緊急手術者共有57例,其中7例拒絕手術治療,終告死亡;50例緊急手術中有6例發生死亡。綜括死亡原因,12例因敗血症引發多器官衰竭,另1例則是胃急性大量出血引致休克。手術合併症有7例,包括2例頸部傷口感染、3例吸入性肺炎,1例腦血管栓塞和1例因食道殘留引起縱膈腔炎。在本報告中並沒有發生因軟式纖維性食道鏡檢查引致醫源性臟器穿孔的合併症。藉此有限臨床回顧分析,我們認為軟式纖維性食道鏡檢查,對於成人急症上消化道急症腐蝕傷,有助於傷情嚴重度的確認,讓決定是否盡早施行手術治療可多一分臨床參考。 |
英文摘要 | Objective: Early use of flexible esophagoscopy in the management of acute phase of corrosive esophageal injury remains controversial in emergency room (ER). The purpose of this retrospective study was to evaluate the essential role of flexible esophagoscopy in both the diagnosis and primary surgical treatment of the acute corrosive esophageal injury in ER. Methods: Four-hundred and forty-nine patients with corrosive injury of the upper gastrointestinal (UGI) tract due to ingestion of a corrosive substance between 1990 and 2000 were included in this retrospectively analysis. Acute lesions were classified into 3 grades according to the findings of esophagoscopic assessment. The criteria for selecting patients for emergency exploratory laparotomy were esophagoscopic findings showing third degree chemical burn of severe corrosive injury or grade 2 chemical burn in the proximal esophagus with suspicion of distal perforation, continuous bleeding from the gastrointestinal tract, or lack of cooperation for esophagoscopic assessment with signs of peritonitis. Results: Following the selection criteria for operation indications, 57 patients (age range 10 to 85 years; mean 44.5 years) with severe injury that underwent esophagoscopic clinical assessment was included in this study. The majority were adult who had attempted suicide, and hydrochloric acid (HCl) was the most common ingested agent. The male/female ratio was 1:2.05. Fifty patients, including grade 2 esophageal injury in 22 patients and grade 3 esophageal injury in 28 patients revealed by esophagoscopy, required surgery due to deep burn and six of them died. Seven patients who were considered to have the surgical indication of grade 3 chemical burn found on the esophagus and stomach was treated conservatively due to refusal of operation, but all of them died. The cause of death was sepsis and multiple organ failure in 12 patients. One patient died as a result of shock secondary to massive gastric bleeding. Operative complications occurred in seven patients, including cervical wound infection in two patients, aspiration pneumonia due to pharyngeal dysfunction in three patients, cerebral infarction in one and acute mediastinitis due to residual esophagitis in one. Conclusions: Our results suggest that early flexible esophagoscopy in the corrosive injury of UGI tract in adults can help delineate the extent of damage caused by corrosive compounds and play an important role as an indicator for early surgery. Early assessment with esophagoscopy by surgeons is essential to the appropriate management with the corrosive injury of UGI tract in ER. |
本系統中英文摘要資訊取自各篇刊載內容。