Pacienti s diagnózou suspektní poleptání jícnu tvoří 15 % všech akutně hospitalizovaných pacientů na naší klinice. Vzhledem k závažnosti onemocnění, jehomožným následkům a komplikacím, považujeme u všechpodezřen í na poži tí leptavé lá tky za prioritní provést včasná diagnosticko-terapeutická opatření na specializovaném pracovišti ORL, které má zázemí ARO se zkušenostmi s otravami, a chirurgického pracoviště, kde se provádějí operace hrudní části jícnu. Základní postupy zahrnují zejména časnou rigidní ezofagoskopii pro určení tíže poleptání; flexibilní ezofagoskopii považujeme za riskantní. Podle ezofagoskopického nálezu rozdělujeme poleptání do čtyř stupňů podle naší pracovní klasifikace. Dále je uveden rozbor souboru dětskýchpacie ntů léčenýchpr o suspektní poleptání jícnu na ORL klinice 2. LF UK v letech 1991 až 2001. Všichni pacienti byli léčeni podle jednotného diagnosticko- terapeutického protokolu.

Patients with the diagnosis of suspect corrosion of esophagus form 15% of all emergency hospitalization patients at our clinic. In view of the severity of the disease, its possible consequences and complications, all cases of suspected swallowing of caustic compounds are given priority for early diagnostic-therapeutic measures at specialized otolaryngology ward, which disposes of the emergency unit experienced in poisoning, and a surgery ward capable of operation on the thoracic part of esophagus. The basic procedures include particularly the timely rigid esophagoscopy for estimating the degree of corrosion; flexible esophagoscopy is considered of posing a risk. The esophagoscopy finding enables to classify the corrosion into four degrees according to our working classification. The patients affected by corrosion of the Ist degree are only subject to observation, whereas the finding of corrosion of the IInd or IIIrd degree indicates that the nasal-gastric probe is to be introduced for the period of six weeks and the therapywith two-stage corticoid treatment and intravenous administration of antibiotics during the first week after the injury. In cases of corrosion of the IVth degree the probe is applied for a longer period of time together with an effort to maintain esophagus as wide as possible and the replacement of esophagus is considered in collaboration withsurgeons at the most suitable period of time. Edema of the entry into larynx is the most frequent acute complication of corrosion of swallowing passages; it is treated by a pharmacological intervention and, whenever insufficient, intubation or, exceptionally, tracheotomy must be made to secure respiratory pathways free. A post-corrosion stricture, which mostly responds to a balloon dilatation favorably, is the most frequent late complication. Extensive strictures limiting the esophagus lumen, which deteriorate the possibility for intake of food and do not respond to balloon dilatation favorably, represent indication for esophagus replacement. Mediastinitis and aorta-esophagus fistula represent the most serious complications. The authors then analyze a cohort of children patients treated for suspect corrosion of esophagus treated at the Otolaryngology Clinic, 2nd Medical Faculty, Charles University, in the years 1991 to 2001. All the patients were treated according to a uniform diagnostic-therapeutic protocol. In the period of observation, 275 patients were examined. When the early rigid esophagoscopy was applied, negative findings were observed in 156 (56.7%) patients, corrosion of the Ist degree in 47 (17.1%) patients, corrosion of the IInd or IIIrd degree in 62 (22.5%) patients and the IVth degree in 10 (3.6%) patients. Two patients with corrosion of the IVth degree died. The death was caused by untreatable mediastinitis withde veloping multiorgan failure. One female patient, who suffered from corrosion of the IVth degree is still affected by a severe post-corrosion stricture which may can not be influenced by the balloon dilatation. All the other patients are completely without any complaints.

Klinika ušní nosní a krční 2 LF UK a FNM Praha 5 Motol

Corrosion of esophagus in children

Poleptání jícnu u dětí = Corrosion of esophagus in children /

Corrosion of esophagus in children /

Lit: 13

Souhrn: eng