分层缝合加带蒂大网膜包埋在食管良性破裂修补术中的应用

Application of stratified suture combined with pedicled omentum capsule in the repair of benign esophageal rupture

目的探讨采用食管黏膜、肌层分层缝合加带蒂大网膜包埋在食管良性破裂修补手术中的应用方法与价值。方法应用分层缝合加带蒂大网膜包埋修补食管良性破裂病人37例,均采用食管黏膜、肌层分层缝合及带蒂大网膜包埋。观察病人术后恢复情况,胸管留置时间,术后14～20天复查上消化道碘水造影结果,住院时间以及出院后随访情况。结果 37例病人术后平均住院时间23. 2天,1例病人术后出现瘘,其余病例均Ⅰ期愈合,随访6～24个月,无迟发瘘及食管狭窄。结论对于食管穿孔或自发性食管破裂病人,如术中发现胸腔、纵隔感染,食管组织水肿时推荐行分层缝合并应用带蒂大网膜移植进行包埋。

Objective To explore the experience and value of stratified suture combined with pedicle greater omentum transplantation in the repair of benign rupture of esophagus. Methods The clinical data of 37 patients with benign rupture of esophagus with pedicled omentum were analyzed. Spontaneous esophageal rupture in 30 cases,esophageal foreign body and perforation in 7 cases. The average duration of surgery was 45 hours. The break length averaged 4. 8 cm. All cases were repaired by stratified suture and pedicled omentum embedding. Results 37 patients were hospitalized on an average of 23. 2 d after operation,1 cases had fistula after operation,all the remaining cases healed well,followed up for 6 - 24 months,no tardive fistula and stricture of the esophagus. Conclusion For patients with esophageal perforation or spontaneous esophageal rupture,if intrathoracic infection or esophageal edema were founded,we recommend stratified suture combined with pedicle greater omentum transplantation.