自发性食管破裂的诊断和及时治疗

Diagnosis and timely treatment for spontaneous rupture of esophagus

目的探讨自发性食管破裂的诊断方法和及时治疗的理念，以提高临床诊疗水平。方法回顾性分析1999年2月至2011年6月本科收治的16例食管自发性破裂的相关临床资料及手术方式。其中中段食管破裂4例，下段食管破裂12例。16例均为1处破口，破裂长度为1．5～5（2．6±1．1）cm，破入左胸11例，右胸2例，无胸腔破入3例，主要症状为胸腹剧烈疼痛、发热、呼吸困难及休克等，查体见液气胸10例，皮下气肿5例。结果全组24h内修补11例，24h后修补5例，均采用可吸收线间断缝合食管，大网膜包埋固定，改良抗返流手术。全组均顺利度过围手术期，无死亡病例。随访无食管狭窄，返流2例，采用保守治疗均明显缓解。结论早期诊断和确诊后及时剖胸探查手术、闭合破裂口重建消化道并大网膜包盖固定、确保消化道连续性是治疗自发食管破裂的关键。

Objective To explore the diagnostic approach and the idea of timely treatment for the spontaneous rupture of the esophagus （SRE） for improvement of the level of clinical diagnosis and treat- ment. Methods The relative clinical data and operation method of 16 cases SRE （4 cases of midpiece SREs and 12 cases of lower SRE） collected from February 1999 to June 2011 were analyzed retrospectively. There were one place breach in 16 cases of SRE with a broken length of 1.5 - 5 cm （2. 6 ± 1.1 ） cm, including 11 cases broken into the left breast, 2 into fight chest, and 3 no chest broken into. The main symptoms included intense thoracoabdomina] pain, fever, difficulty in breathing, and shock. Ten cases of hydropneumothorax and 5 cases of subcutaneous emphysema were found with physical examination. Results Eleven cases were repaired within 24 hours and 5 cases were repaired after 24 hours. The esophaguses of 16 cases were sutured disconnectedly by absorbable suture line, to which omeutum majus were sutured and fixed. Improved resisting backflow operation was carried out for 16 cases which got through the perioperative period smoothly and no deaths. There was no esophageal narrow in follow-up visit, otherwise, there were 2 refluxes that relieved significantly through conservative treatment. Conclusions It is the key to treat SRE that early diagnosis and exploration operation through cutting thorax after definite diagnosis, closing broken hole in order to rebuild the alimentary canal on which omentum majus was covered and fixed for the purpose of insuring continuity of digestive tract.