胸段食管穿孔的急诊手术治疗分析

Emergency surgical treatment of the thoracic esophageal perforation

目的探讨食管穿孔外科的治疗原则、治疗时机及如何选择合理的治疗方式。方法回顾分析食管破裂患者29例。所有患者均实行急诊手术,开胸食管穿孔修补术+纵隔切开引流术19例。纵隔切开引流术10例,其中1例于9个月后行食管下段切除、胃食管主动脉弓下吻合术;3例经修补术再次发生食管胸膜瘘后置入食管覆膜支架。结果 I期愈合17例(58.6%);6例(20.7%)形成慢性食管胸膜瘘,经引流后愈合。1例行食管下段切除、胃食管主动脉弓下吻合术,术后顺利恢复出院。5例死亡,死亡率17.2%。死亡原因为感染性休克2例,多器官功能衰竭3例。3例置入支架者1例愈合,2例支架取出后愈合。结论早期诊断处理是食管穿孔预后的最重要因素,早期治疗、根据病情个性化治疗、选择合适的治疗方法,是提高食管破裂治愈率、降低病死率的关键。

Objective To study the principle of thoracic esophageal perforation surgical treatment,timing of treatment and how to choose a reasonable treatment.Methods 29 cases with esophagus perforation were reviewed.All patients were implemented the emergency surgery.The thoracic esophageal perforation repair and mediastinal thoracic drainage were operated for 19 cases.The mediastinal incision and drainage were operated for 10 cases;the lower esophageal resection and esophagogastrostomy were operated on one case after nine months.The stents were placed in three cases that had chronic esophageal fistula after repair.Results Phase I of the healing were in 17 cases（58.6%）,and chronic esophageal fistula were in 6 cases（20.7%） and healed by drainage.The lower esophageal resection and esophagogastrostomy recovered smoothly.Five cases were died and the mortality was 17.2%.The cause of death was septic shock in two cases and multiple organ failure in three cases.One case was healing with stent and two cases were healing after taking out the stents.Conclusion Early diagnosis and treatment is the most important factor in prognosis of esophageal perforation.Early and personalized treatment,select the appropriate treatment can improve the cure rate of the esophagus perforation.