食管破裂的诊断与治疗  

The diagnosis and surgical treatment of esophageal rupture

作　　者：傅毅立[1] 李辉[1] 侯生才[1] 胡滨[1] 李彤[1] 苗劲柏[1] 

机构地区：[1]首都医科大学附属北京朝阳医院胸外科,100020

出　　处：《中华胸心血管外科杂志》2015年第5期267-269,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 总结食管破裂的诊断及处理经验.方法 回顾12例食管破裂患者的临床资料,经X线胸片、胸腔闭式引流、上消化道造影、胸部CT或胃镜确诊.自发性食管破裂6例,异物导致食管破裂4例,医源性食管破裂2例.手术治疗8例,其中急诊食管一期缝合并带蒂膈肌瓣或大网膜覆盖6例;食管近、远两端结扎并切除破裂区域,二期行食管切除胃食管吻合术2例;保守治疗4例.结果 7例首诊确诊为自发性食管破裂和医源性食管破裂均经外科手术治疗治愈出院,住院时间17～53天,出院后随访3个月～5年,未见食管相关并发症.1例外院转入患者误诊时间较长,经保守治疗后病情相对稳定后行手术治疗,术后死于感染中毒性休克.食管异物致破裂4例,经胸部CT及胃镜确定裂口均小于5 mm,保守治疗后痊愈.结论 食管破裂经详细了解病史和X线胸片、胸腔闭式引流、胸部CT及上消化道造影等检查可明确诊断.根据患者全身情况尽早选择适当方法封闭裂口是治疗的关键,同时予以充分引流、控制感染以及营养支持治疗.Objective Summarize the experience of diagnosis and treatment of esophageal rupture.Methods Twelve cases of esophageal rupture were treated with surgical intervention and clinical data were analyzed retrospectively.Diagnosis was confirmed in all patients by chest X-cays,Closed thoracic drainage,upper gastrointestinal contrast,chest CT scan and gastroscopy.In this series,there were 6 cases of spontaneous esophageal rupture,2 cases of iatrogenic esophageal rupture,4 cases of foreign body in esophagus rupture.For surgical treatment of 8 cases,including emergency esophageal stitching issue and diaphragmatic muscle or greater omentum to cover 6 cases;Esophageal ligation and resection of rupture area on both closes of the near and far,phase ii gastroesophageal anastomosis of esophagus resection in 2 cases,including 1 case of esophagus repair failure after turning the operation）.Esophageal resection of gastroesophageal anastomosis in 1 case （for into the outer court misdiagnosed patients）;4 cases were conservative.Results Initial diagnosis of spontaneous esophageal rupture and iatrogenic esophageal rupture 7 patients were cured,17 to 53 days of hospital stay,Follow-up for 3 months to 5 years,no esophageal related complications.Exception 1 patient died of postoperative infection（misdiaguosed for a long time）.4 cases of esophageal foreign bodies to rupture were cured and these cases＇ fissure were less than 5 mm by chest CT scan and gastroscope diagnosis.Conclusion Complete collection of medical history,chest X-cays,Closed thoracic drainage,upper gastrointestinal contrast,chest CT scan and gastroscopy may clear diagnosis.Choose the proper method according to the patients as early as possible by general closed gap is the key to the treatment,at the same time be adequate drainage,control of infection and nutrition support treatment.

关 键 词：食管破裂 诊断 治疗 

分 类 号：R655.4[医药卫生—外科学]