自发性食管破裂的诊断和外科治疗

The diagnosis and surgical treatment of spontaneous esophageal rupture

目的:探讨自发性食管破裂的诊断和外科治疗。方法 :对 14例自发性食管破裂患者的诊断、治疗方法及治疗结果进行回顾性分析。结果:本组确诊时间 2 4 h以内者仅 2例 ,确诊时间大于 2 4 h者 12例 ;一期食管修补、带蒂胸膜覆盖术 3例 ,治愈 1例 ,治疗失败 2例 (其中 1例死亡 ,1例延期行结肠代食管术后治愈 ) ;行破裂段食管切除、胃 -食管吻合术的 5例全部治愈 ;保守治疗 6例 ,治愈及死亡各 3例。结论:早期诊断自发性食管破裂是提高疗效、降低病死率的关键。发病 2 4 h以上者 ,如全身情况允许 ,破裂段食管切除、胃 -食管吻合术的疗效较好。

Objective: To investigate the diagnosis and surgical treatment of spontaneous esophageal rupture. Methods: From May 1977 to February 2004,14 patients with spontaneous rupture of esophagus were surgical treated. The diagnosis,treatment and outcome of this patients were analysed retrospectively. Results: Only 2 cases were diagnosed within 24 hours of onset. Primary repair was performed in 3 cases and 2 failed. 1 of these two patients died and 1 retreated with retrosternal colon replacement of the esophagus and cured. Transthoracic esophagectomy was performed in 5 cases and all were cured. Conservative therapy with close drainage of thoracic cavity and nutritional support in 6 cases,3 patients were cured and other 3 died. Conclusion: Early diagnosis is the key point to patients' therapy. Surgical treatment with transthoracic esophagectomy is better than primary repair in most patients.