内镜下胃造瘘空肠置管或支架置入治疗自发性食管破裂  

Treatment of spontaneous esophageal rupture with percutaneous endoscopic jejunostomy or stent intervention

作　　者：杜宗汉[1] 周丽峰[1] 李世清[1] 罗晖[1] 陈龙[1] 周晓晴[1] 

机构地区：[1]南充市中心医院川北医学院第二临床医学院,四川南充637000

出　　处：《山东医药》2015年第47期20-22,共3页Shandong Medical Journal

基　　金：四川省教育厅自然科学基金(152ZB0198)

摘　　要：目的观察内镜下胃造瘘空肠置管或支架置入治疗自发性食管破裂的效果。方法 21例自发性食管破裂患者,其中食管纵隔瘘5例、食管胸腔瘘16例,食管纵隔瘘采用禁食、抗感染及经皮内镜下胃造瘘空肠置管肠内营养治疗,食管胸腔瘘行胸腔闭式引流、抗感染及胃镜下全覆膜可回收支架置入,观察患者并发症、住院时间及转归情况。结果 20例患者恢复良好,未见明显并发症。5例食管纵隔瘘患者恢复良好,住院时间9～22 d。16例食管胸腔瘘患者中1例因严重肺部感染死于呼吸衰竭,余15例恢复良好,住院时间18～27 d。结论内镜下胃造瘘空肠置管或支架置入治疗自发性食管破裂效果好,值得临床推广。Objective To observe the efficacy of percutaneous endoscopic jejunostomy or stent intervention in treatment of spontaneous esophageal rupture（ SER） under endoscope. Methods A total of 21 patients with SER were enrolled,including 5 patients with mediastino-esophageal fistulas and 16 patients with esophago-pleural fistula. The patients with mediastino-esophageal fistulas were treated with fasting,anti-infection and nutritional support by percutaneous endoscopic jejunostomy（ PEJ）. The patients with esophago-pleural fistula underwent closed drainage of thoracic cavity,anti-infection and stent intervention under gastroscope. The complications,length of hospital stay and outcome of patients were analyzed. Results Twenty patients recovered well and no obvious complications were found. Five patients with mediastino-esophageal fistulas recovered well,and the time of hospital stay was（ 9-22） d. During 16 patients with esophago-pleural fistula,1 case died of respiratory failure due to serious lung infection,15 cases recovered well,and the time of hopital stay was（ 18-27）d. Conclusion The effect of using percutaneous endoscopic jejunostomy or stent intervention in treatment of SER is good,which is worthy of clinical application.

关 键 词：自发性食管破裂 胃镜 支架置入 胃造瘘 空肠置管术 

分 类 号：R655.4[医药卫生—外科学]