前路頸椎手術後食道穿孔併發症－案例報告

Anterior Cervical Spine Surgery Complicated by Esophageal Perforation: A Case Report

林芷伃(Jhih-Yu Lin) ； 洪碩穗(Shuo-Suei Hung)

《台灣專科護理師學刊》 6卷1期 (2019/03) Pp. 41-46

摘要

頸椎病變常需接受前路頸椎手術治療，而術後可能出現的併發症包括傷口感染、血腫、硬腦膜撕裂和腦脊髓液滲漏、聲帶麻痺、食道穿孔及吞嚥困難，因此需謹慎評估和監測。此病患是一位57歲男性，因頸椎病變接受前路頸椎手術，術後傷口無感染症狀，但進食流質時有嗆咳及吞嚥困難現象，在類固醇藥物使用後，症狀緩解後出院。因喉嚨處有灼熱疼痛及吞嚥困難於當日回急診就醫，影像檢查確診為食道穿孔併深頸部感染，接受清創及食道修補手術。術後第八天，發現食道修補處有滲漏現象，再次接受肌瓣修補手術，以及引流管、鼻胃管、營養照護與感染控制等治療，於住院四十一天後，順利康復出院。食道穿孔是罕見的併發症，一旦發生，極有可能會危及生命。常見早期症狀有吞嚥困難、聲音沙啞、肺炎、發燒及呼吸困難等。接受前路頸椎手術後出現以上症狀，就應高度懷疑食道穿孔，才能早期發現並即時治療，進而降低併發症及死亡率，甚至可降低醫療糾紛的發生。

關鍵字

前路頸椎手術 ； 併發症 ； 食道穿孔 ； 吞嚥困難

並列摘要

Anterior cervical spine surgery is a common procedure to treat cervical spondylosis. Its possible complications include wound infection, hematoma, dural tear, cerebrospinal fluid leakage, vocal cord paralysis, esophageal perforation, and dysphagia; therefore, careful evaluation and monitoring are necessary. This patient was a 57-year-old male who underwent anterior cervical spine surgery due to cervical spondylosis. After the operation, he had no obvious wound infection but complained of choking and difficulty swallowing his liquid diet. He was discharged after achieving symptomatic relief via the use of steroids. However, he experienced sore throat, local heat, and dysphagia a few hours later and returned to our emergency room for further evaluation. Additional imaging studies revealed esophageal perforation with deep neck infection. He then underwent esophageal repair and debridement. Leakage was found at the repair site on the eighth postoperative day, and rotational muscle flap coverage was performed. After these treatments and with adequate drainage and nutritional support, his condition gradually improved, and he was discharged 41 days after rehospitalization. Esophageal perforation is a rare and possibly fatal complication which can occur after anterior cervical spine surgery. Esophageal perforation should be particularly suspected, even when the patient presents common symptoms such as dysphagia, hoarseness, pneumonia, fever, or dyspnea, any of which may occur after anterior cervical spine surgery. The only way to minimize the consequences of this potentially serious complication is through early detection and timely treatment.

並列關鍵字

anterior cervical spine surgery ； complications ； esophageal perforation ； dysphagia

參考文獻

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