食管破裂与穿孔15例的临床诊治分析

Analysis of clinical diagnosis and treatment 15 patients with esophageal rupture and perforation

目的探讨食管破裂与穿孔的诊断与治疗,提高对该疾病的诊治水平。方法总结分析我科15例食管破裂与穿孔的临床病例资料。颈段食管穿孔3例,2例为异物所致,1例为外伤所致,均手术治疗,胸段食管破裂穿孔12例,其中自发性食管破裂穿孔4例,食管异物损伤5例,外伤性食管穿孔2例,医源性损伤1例,根据食管的损伤程度及感染累及范围分别采取食管切开异物取出食管修补,食管部分切除,纵隔引流,瘘口修补等手术治疗12例。结果 15例食管破裂与穿孔治愈13例;1例死于合并糖尿病因胸腔和纵隔感染严重,中毒性休克,呼吸衰竭,肾功能衰竭;1例死于食管癌引发食管破裂穿孔致感染性休克,多器官衰竭。结论根据食管破裂与穿孔的大小、时间、部位、纵膈和胸腔污染程度,早期明确诊断,及时采取合适的手术方式是治疗的关键。

Objective To investigate the diagnosis and treatment of esophageal rupture and perforation in order to improve the diagnosis and treatment level of this disease. Methods Clinical data of 15 patients with esophageal rupture and perforation in our department were summarized and analyzed. There were 3 cases of cervical segment esophageal perforation,of which 2 cases were caused by foreign matters and 1 case was caused by trauma,and all cases were treated by surgery. There were 12 cases of thoracic segment esophageal rupture and perforation,of which 4 cases were spontaneous esophageal rupture and perforation,5 cases were esophageal foreign matter injury,2 cases were traumatic esophageal perforation,and 1 case was iatrogenic injury. According to the injury degree of esophagus and the infection involved area,12 patients received esophageal incision,foreign body removal and esophageal repair, esophageal partial resection,mediastinum drainage,orificium fistulae repair and other surgical treatment respectively. Results Of the 15 patients with esophageal rupture and perforation,13 patients were cured. 1 patient died of complicating diabetes and toxic shock,respiratory failure and renal function failure caused by severe thoracic cavity and mediastinum infection.1 patient died of septic shock and multi-organ failure caused by esophageal cancer-induced esophageal rupture and perforation. Conclusion Early and definite diagnosis and timely application of appropriate surgical methods based on the size,time,location,mediastinum and thoracic cavity infection degree of esophageal rapture and perforation are key to the treatment.