Cervical, mediastinal, or thoracic drainage

Perforation of the esophagus for more than 24 hours, often due to rancid infection in the mediastinum and pleural cavity and severe inflammatory edema of the esophageal wall, it is difficult to complete the first-stage suture repair. According to the location, severity and physical condition of the perforation of the esophagus, corresponding measures and operations should be taken to control and reduce the source of pollution, and to promote the improvement of the general condition and the healing of the perforated esophagus. Common surgical methods include patch repair of esophageal perforation, cervical, mediastinal or thoracic drainage, total thoracic esophagectomy, cervical esophagus and gastrostomy, and esophageal lumen management. Treatment of diseases: empyema and esophageal perforation Indication Neck, mediastinum or chest drainage is available for: 1. The neck esophagus perforation for more than 24h or conservative treatment, fever, white blood cell count, neck mediastinal infection and abscess formation, surgical drainage through the neck. 2. Thoracic esophageal perforation, infection is limited to the mediastinum without drainage into the chest. 3. If the infection has worn the pleura to form empyema, closed thoracic drainage should be performed. Preoperative preparation Anesthesia and position Local infiltration anesthesia. If you need to take a foreign body removal or a more complicated operation, you can also use a tracheal intubation for general anesthesia. Take the appropriate position according to the needs of the operation. Surgical procedure Surgical procedure 1. Abdominal abscess drainage The incision is taken on the side where the neck is swollen and tender. If both sides are tender and swollen, the right neck incision is used. Because the esophagus is far from the right pleura, the gap is wide and it is not easy to accidentally injure the pleura. Puncture should be performed to further define the abscess before cutting. Through the anterior incision of the sternocleidomastoid muscle, the anterior cervical muscle group is cut, and the abscess is found and cut. If the foreign body is perforated, the foreign body should be taken out. If the abscess is confined to the neck, double cigarette drainage can be placed; if the posterior mediastinal abscess is formed, a cigarette-type drainage is placed above the abscess, and a double-chamber soft hose is placed under the drainage. 2. Back mediastinal drainage According to the results of X-ray examination, the mediastinum abscess was selected at the right side of the spine, and then the skin and muscle layer were cut, and the posterior segment of 1 or 2 ribs was removed, and the pleura was pushed open to expose the mediastinum and abscess. Place a thicker soft hose for drainage. 3. Thoracic drainage A thick tube closed drainage was placed at the lowest position of the abscess. The surgical procedure is the same as closed thoracic drainage.