自发性食管破裂的诊断和治疗(附6例临床报道及文献复习)

Diagnosis and treatment of spontaneous rupture of esophagus(reportd of 6 cases Boerhaave's syndrome and a review of the literature)

目的总结自发性食管破裂(Boerhaave's syndrome)诊断和治疗的经验。方法对我院治疗的6例自发性食管破裂病例的诊断、治疗、结果进行回顾性分析,并结合文献复习。结果本组病例4例在48h内确诊并手术,2例经手术探查确诊。本组病死率为50%(3/6)。行一期修补术的3例中有2例距发病起过24h,成功2例。结论高度警惕本病并迅速获得全面、准确的发病史是避免误诊、漏诊的关键。诊断主要根据胸片、食管造影及特征性的胸腔引流物。早期诊断和选择合理术式进行治疗是提高本病疗效,降低病死率的关键。

Objective To summarize the experiments of diagnosis and treatment of spontaneous rupture of esophagus （Boerhaave＇s syndrome）. Methods To retrospective review and analyze the diagnosis,treatments and results of 6 patients of spontaneous rupture of esophagus treated in our hospital, and connection to review literature. Results Early diagnosis and operation were performed on 4 cases （〈48h） of the group and 2 cases were diagnosed from intraoperatively. The mortality rate was 50 % （3/6） in our group ,3 cases of the patients admitted primary repair 2 cases over 24h,2 were successful. Conclusion A rapid but complete and accurate grasp of history ,remaining high alert on the disease is the key to avoid misdiagnosis. The diagnosis can be confirmed or excluded by a chest film, a opacification of the esophagus or characteristic contents in thoracic fluid. Early diagnosis and appropriate surgical treatments are the key to increase the curative effect and reduce the mortality rate.