胸段自发性食管破裂的诊治

Diagnosis and treatment experience on spontaneous rupture of thoracic esophagus

目的总结胸段自发性食管破裂的诊断和治疗经验。方法回顾性分析10例胸段自发性食管破裂患者的诊断和治疗情况。结果7例患者通过胸腔闭式引流获得早期诊断，其中6例行一期手术修补，1例仅行胸腔闭式引流术。3例晚期患者行分期手术治疗。10例患者均痊愈。结论立即胸腔闭式引流是尽早诊治的重要措施。一期修补是早期患者比较理想的治疗方式。对于晚期重症患者，要根据患者具体情况决定治疗策略，分期手术能够降低手术风险。

Objective To summarize the experience of diagnosis and treatment for spontaneous rupture of thoracic esophagus. Method The diagnosis, treatment and results of 10 patients with spontaneous rupture of thoracic esophagus were analyzed retrospectively. Results 7 cases received early diagnosis by prompt drainage. 6 underwent primary repair and another 1 underwent pleural drainage only. 3 patients with delayed spontaneous rupture of thoracic esophagus underwent staged operations. All cases were cured. Conclusion Prompt drainage of pleural cavity is the key point for early diagnosis and treatment. Primary repair is the best choice for early spontaneous rupture of thoracic esophagus. As for critically ill patients with delayed spontaneous rupture of esophagus during later period, surgery strategy should be individualized according to specific circumstances and staged operations which can decrease mortality.