自发性食管破裂2例临床诊治体会及文献复习

Experiences of the clinical diagnosis and treatment of two cases with spontaneous esophagus rupture and literature review

目的:探讨自发性食管破裂的临床特点、诊断、鉴别诊断和治疗,提高临床诊治能力。方法:对2例自发性食管破裂的临床资料进行回顾性分析,并复习相关文献。1例确诊后24 h内转胸外科手术治疗;1例予胸腔冲洗和闭式引流、抗感染治疗。结果:1例手术修补后治愈,另1例病情恶化家人放弃治疗。结论:高度警惕并迅速获得全面、准确的发病史是避免漏诊、误诊的关键;胸片、胸腔穿刺、食管造影和特征性的胸腔引流物有助于诊断;早期诊断和及早手术修补破裂口和通畅引流是治疗的关键。

Objective：To explore the clinical characteristics,diagnosis ,differential diagnosis and treatment of spontaneous esophageal rupture and improve the clinical diagnosis ability. Methods： The clinical data of 2 cases with spontaneous esophageal rupture were retrospectively analyzed and the literatures were reviewed. One case was surgical treatment within 24 hours, other case was treated with lavaging, drainaging and anti-infection. Results：One case cured through repairing, other case worsened because of his family giving up treatment. Conclusions ： Obtaining complete and accurate disease history is the key to avoid misdiagnosis. The chest radiograph, chest puncture,esophageal angiography and distinctive chest drainage can help diagnosis. The early diagnosis and surgerical repair and unobstructed drainage is the key of treatment.