自发性食管破裂的早期诊断和外科治疗

Early diagnosis and surgical treatment of spontaneous esophageal rupture

目的探讨自发性食管破裂临床特征、诊断、鉴别诊断和外科治疗,以提高临床诊治水平。方法回顾性分析17例自发性食管破裂患者的相关临床资料,并结合文献进行分析。结果17例中男16例,女1例;年龄11～81岁,平均47.8岁;全部为胸段食管破裂,食管中段2例、下段16例(其中1例2处破口),破入左胸10例,右胸6例,双侧1例,破裂长度为0.8～6cm,平均3.7 cm;主要症状为胸腹剧烈疼痛、发热、呼吸困难及休克等,查体可见液气胸,部分患者可见皮下气肿。全组24小时内修补6例,24小时后修补4例;5例予以胸腔冲洗和单纯引流治疗;1例26小时行末端食管贲门切除,食管残端封闭,胃造瘘和食管颈部造瘘;1例4天行胸内胃食管吻合术;全组共死亡3例。结论早期诊断和尽早手术闭合破裂口和通畅引流是治疗的关键。进行胸腔穿刺、上消化道造影等检查可帮助诊断。

Objective To explore clinical characteristics, diagnosis, differential diagnosis, and surgical treatment of spontaneous esophageal rupture, and thereby to improve the level of clinical diagnosis and treatment, nothods Clinical data of 17 patients with spontaneous esophageal rupture were retrospectively analyzed and the literatures were reviewed. Results In the 17 patients, 16 cases were male, 1 were female;Their age ranged from 11 to 81 -year-old （ mean 47. 8-year-old） ;Ruptured location were all in thoracic esophagus. 2 patients were in middle segment, 16 patients were in lower segment esophagus. 10 patients had the rifts in left throx and 6 had in right throx. The length of rupture ranged from 0. 8 to 6 cm（ mean 3.7 cm）. Main manifestations included intensive pain in chest and abdomen,fever,dyspean, and shock. Physical examination showed the sign of hydropneumothorax, and subcutaneous emphysema in some patients. 6 patients were cured within 24 hours, and 4 patients were after 24 hours. 5 patients were performed lavaging and drainaging on the chest. 1 patient was carried out esophagocardiac resection, esophageal stump closure, gastricostomy, and neck esophagostomy in 26^th hours. 1 patient was performed via chest gastroesophageal anastomosis on the 4^th day. 3 patients died postoperatively. Conclusion The crucial point of the surgical treatment lies in its early diagnosis and the use of drainage smoothly. Thoracoccntesis and upper alimentary tract contrast examination can help in the diagnosis.