成人自发性食管破裂外科治疗的效果

Effect of surgical treatment on spontaneous rupture of the esophagus in adults

目的探讨外科治疗成人自发性食管破裂的效果。方法66例成人自发性食管破裂患者中，63例急诊行开胸探查食管破裂修补术，3例胸腔镜下脓胸清除引流术。破裂12h内手术行单纯破裂修补术，破裂〉12h行破裂修补＋带蒂肌瓣覆盖加强。结果Ⅰ期修补愈合比例83．3％（55／66），术后瘘发生比例12．1％（8／66）。发生术后食管漏者，经积极抗炎、胸腔引流、支持治疗，8例均痊愈。2例（3．0％）患者由于严重的纵隔炎及脓毒血症死亡。结论早期诊断及严密的治疗计划和实施是改善自发性食管破裂预后的关键。外科积极Ⅰ期单纯修补破口（早期破裂，12h内）或破口修补＋带蒂肌瓣覆盖加强（延迟破裂，〉12h）安全可行，值得推广。

Objective To investigate the esophagus in adults. Methods Sixty-six the effect of surgical treatment of spontaneous rupture ot cases of spontaneous rupture of the esophagus in adults were treated by open chest exploration for esophageal rupture repair and thoracoscopy assisted drainage of empyema. Results The proportion of primary healing was 83.3% （55/66）, and the proportion of post- operative leak was 12. 1% （8/66）. Eight cases of postoperative esophagus leakage were cured by active anti-inflammatory, thoracic drainage and support treatment. Two patients （3.0%） died of severe mediastinitis and sepsis. Conclusions Early diagnosis and careful treatment planning and implementation are the key to improve the prognosis of spontaneous rupture of esophagus. Surgical treatment is a safe and feasible procedure for primary repair of ruptures （early rupture, within 12 hours） or repair with pedicle muscle flap coverage （delayed rupture, more than 12 hours）, which can be popularized.