胸腔镜胃镜双镜联合治疗自发性食管破裂的研究  

Study on the treatment of spontaneous esophageal rupture with thoracoscopic gastroscopy

作　　者：杨楠[1] 熊磊[1] 齐晨 陆恒[1] 魏凌云[1] YANG Nan;XIONG Lei;QI Chen;LU Heng;WEI Ling-yun(Department of Cardiothoracic Surgery,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院(原南京军区南京总医院)心胸外科,南京210002

出　　处：《医学研究生学报》2021年第3期249-251,共3页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81702444)。

摘　　要：目的早期彻底行胸腔内清创、冲洗、置管引流,对于食管破裂口的愈合意义重大。文中旨在研究胸腔镜联合胃镜治疗自发性食管破裂的临床疗效及可行性。方法选取2014年2月至2018年2月东部战区总医院心胸外科收治的16例自发性食管破裂患者。均采用胸腔镜清创、胸腔闭式引流管置入引流,联合胃镜经鼻置入经鼻食管破口冲洗引流管,经鼻置入十二指肠营养管,观察患者住院时间及转归情况。结果所有患者食管瘘口全部自行痊愈,平均痊愈时间38.75 d。其中2例患者出现肺部感染行二次气管插管、呼吸机辅助呼吸治疗联合抗感染,1周后成功脱离呼吸机,其余患者未出现肺部感染、心律失常及全身严重感染等并发症。所有患者术后平均住院时间16.50 d。结论胸腔镜联合胃镜在治疗自发性食管破裂中效果好,值得临床推广应用。Objective Early and thorough intrathoracic debridement,irrigation and catheter drainage are of great significance for the healing of esophageal rupture.This study aims to investigate the clinical efficacy and feasibility of thoracoscopy combined with gastroscopy in the treatment of spontaneous esophageal rupture.Methods A total of 16 patients with spontaneous esophageal rupture were selected from the Department of Cardiothoracic Surgery of the General Hospital of the Eastern Theater Command from February 2014 to February 2018.All of them were treated with thoracoscopic debridement,thoracic drainage with closed drainage tube,nasal drainage with gastroscope,nasal drainage through nasal esophagus incision,and nasal duodenal feeding tube placement.The length of hospital stay and outcome of the patients were observed.Results Esophageal fistula healed spontaneously in all patients,with an average healing time of 38.75 days.Two patients with pulmonary infection received secondary endotracheal intubation,ventilator assisted breathing therapy combined with anti-infection,and were successfully left the ventilator after 1 week.The other patients did not have pulmonary infection,arrhythmia or severe systemic infection.The mean postoperative hospital stay of all patients was 16.50 days.Conclusion Thoracoscopy combined with gastroscopy is effective in the treatment of spontaneous esophageal rupture and is worthy of clinical application.

关 键 词：自发性食管破裂 胸腔镜 胃镜 

分 类 号：R687.4[医药卫生—骨科学]