损伤性食管穿孔的早晚期治疗(附14例报告)

EARLY AND LATE TREAMENT OF TRAUMATIC ESOPHAGEAL PERFORATIONS

报道14例早晚期损伤性食管穿孔治疗的临床经验。提出食管穿孔不能仅满足于确诊,应对食管穿孔部位、大小、粘膜损伤程度及有无食管周围组织损伤作出全面了解。而X线检查是全面了解食管穿孔及合并情况准确、重要的检查手段,正确选择手术入路,疑伴有主动脉损伤应急诊剖胸手术,禁忌食管镜摘取异物。早期食管穿孔以手术为主,可选择修补术、食管切除胃食管吻合术;晚期食管穿孔可选择保守治疗、修补手术及颈部食管外置病情稳定后食管重建手术。本组14例,治愈9例,好转2例,死亡3例(其中2例合并主动脉瘘),病死率21.4%。

This paper resport a clinical experience of early and late treatment for traumatic esophageal perforation on 14 patients. It is suggested that confirmed diagnosis of esophageal perforation is not enough. The region, size of esophageal perforation, traumaeal condition of esophageal musica and of organ around esophagus must be eognized completely. X-rays examination is the accurate and important measure for cognizing completitely the condition of esophageal perforation and complication. The route of operation entry must be selected correctly. If the aortic injury is doubted, the exploratory thoraeotomy ought to be performed immediately, that esophago foreign bodys are eatched by esophagoseope is contraindication. Treatment of early esophageal perforation is operation mainly. The repair of esophagus, esophagectomy and esophagogastrostomy can he selected. The conservative treatment, repair of esophagus, esophageal reestablished when disease condi- tion is stabilization after cervical esophagostomy externa can be selcted for late esophageal perforation, of 14 patients. Cure of 9 patients, improvement of 2 patients. death of 3 pationts with a mortality of 21.4 %. (among death of 3 patints death from concurrent aortic injury of 2 patients.)