自发性食管破裂的诊断和治疗

The Diagnosis and Treatment of Spontaneous Esophageal Rupture

目的:探讨自发性食管破裂(Boerhaave's综合征)的诊断和治疗。方法:回顾性分析我院自1990年以来收治的15例自发性食管破裂的临床资料。均为胸段食管破裂,其中中段5例,下段10例;破裂至右侧胸腔8例,左侧胸腔6例,破裂至纵隔但尚未穿破纵隔胸膜者1例。结果:12例通过口服美蓝、碘剂造影得到确诊,3例行内镜检查得到确诊。1例保守治疗治愈,1例行单纯胸腔引流+冲洗,死于破裂后严重感染;11例于发病24h内手术修补,其中10例治愈,1例死于再破裂;另2例于发病24h后行破裂段食管切除食管胃吻合术,均治愈。结论:增强对本病的认识,详细采集病史及查体,口服美兰后胸穿及碘剂造影或胃镜检查有助于减少误诊和诊断。充分引流和及时开胸手术是有效而可靠的治疗方法。

Objective： To discuss the diagnosis and treatment of Boerhaave＇ s syndrome. Methods： 15 patients with spontaneous esophageal rupture admitted in our department from June 1990 to October 2007 were retrospectively studied. Results： 12 cases were made a definite diagnosis by taking methylene blue. l case was cured by conservative treatment. 1 case was died of severe sepsis . 13 cases were got over by open thoraeotomy, l case died of second esophageal rupture after operation. Conclusion： It＇ s helpful for the diagnosis of Boerhaave＇ s syndrome to make a thoracentesis after taking ethylene blue or take radiography after iodine preparation. As early as possible losed drainage of pleural cavity or open thoracotomy is fairly effective treatment.