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Khirurgii

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Year 2014 Vol. 22 No 1

GENERAL AND SPECIAL SURGERY

V.I. BELOKONEV, S.Y. PUSHKIN, À.S. BENYAN, I.R. KAMåEV, M.P. AYRAPETOVA

THE PECULIARITIES OF DIAGNOSTICS AND TREATMENT OF PATIENTS WITH ESOPHAGEAL TRAUMA CAUSED BY METALLIC DEVICES FOR CERVICAL SPINE FIXATION

SBEE HPE “Samara State Medical University”1,
SBME SO “Samara Regional Clinical Hospital named after M.I. Kalinin” 2,
The Russian Federation

Objectives. To determine the peculiarities of the esophageal trauma caused by metallic devices for cervical spine fixation and work out intraoperative treatment tactics.
Methods. The treatment analysis of 14 patients with the esophageal trauma caused by the cervical spine fixation caused by metallic devices has been carried out. The complications have been confirmed by the esophageal roentgenography and computed tomography (CT). All patients have been operated on. The operation characteristics depended on the alterations in the esophageal wall, perforation size, kind of injury and mediastinitis prevalence.
Results. Three mechanisms of the esophageal trauma are distinguished: 1) when metallic devices placement; 2) as the result of the device pressure on the esophageal wall or migration of the fixed screws into the organ lumen; 3) when devices removal. The first kind of the injury was registered in 5 patients, the second in 5, and the third – in 4. The partial suturing of the esophagus was done in 6 patients, the partial suture incompetence occurred in 2 cases and it resulted in the repeated operations. The partial suturing of the defect and through luminal transesophageal drainage of the fistula and mediastinum in the manner of V.I. Belokonev (2005) has been performed in 8 patients. The drainage of the esophageal perforation through its lumen contributed to forming of the tubular fistula which closed on its own. One out of 14 patients died from multiorganic failure and sepsis.
Conclusions. Esophageal injury by the metallic device used for the vertebral fixation has the peculiarities of clinical course. The suturing of the esophageal defect in combination with the suture line strengthening by the local tissues is indicated in the cases of minor changes of the esophageal wall and absence of pyogenic inflammations. In pyogenic necrotic lesions and fistula recurrence the esophageal defect suturing in the combination with a through luminal transesophageal drainage of the trauma and mediastinum area is required. The suturing of the esophageal defect and the suture strengthening m. sternocleidomastoideus on the pedicle complemented by a through luminal transesophageal drainage have advantage in comparison with the esophageal wall suturing without drainage.

Keywords: vertebral instability, spondylodesis, metallic devices, injury of esophagus, treatment
p. 51 -57 of the original issue
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Address for correspondence:
443095, Rossiiskaia Federatsiia, g. Samara, ul. Tashkentskaia, d. 159, GBUZ SO «Samarskaia oblastnaia klinicheskaia bol'nitsa im. M.I. Kalinina»,
e-mail: serpuschkin@mail.ru,
Pushkin Sergey Yur’evich
Information about the authors:
Belokonev V.I. MD, professor, a head of the surgical diseases chair ¹2 of SBEE HPE “Samara State Medical University”.
Pushkin S.Yu. MD, a deputy chief physician of surgery of SBME ND “Samara Regional Clinical Hospital named after M.I. Kalinin”, a head specialist of Ministry of Health of Samara region (thoracic surgery).
Benyan A.S. PhD, a head of the surgical thoracic department of SBME ND “Samara Regional Clinical Hospital named after M.I. Kalinin”.
Kameev I.R. A thoracic surgeon of the surgical thoracic department of SBME ND “Samara Regional Clinical Hospital named after M.I. Kalinin”.
Ayrapetova M.P. A thoracic surgeon of the surgical thoracic department of SBME ND “Samara Regional Clinical Hospital named after M.I. Kalinin”.
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