异物性胸段食管穿孔12例的诊治探讨  

Discussion on diagnosis and treatment of 12 patients with intrathoracic oesophageal perforation caused by foreign body

作　　者：张焰 卢萍 

机构地区：[1]武汉市第三医院耳鼻咽喉科,武汉430060

出　　处：《临床耳鼻咽喉科杂志》2004年第3期145-146,共2页Journal of Clinical Otorhinolaryngology

摘　　要：目的 :探讨降低异物所致胸段食管穿孔患者死亡率的对策。方法 :对 12例异物所致胸段食管穿孔患者均行开胸探查 ,并根据具体情况分别采用 :①食管镜下取出异物加Ⅰ期食管修补术 (3例 ) ;②食管壁切开取出异物加食管“T”型管引流术 (5例 ) ;③食管壁切开取出异物加食管“T”型管引流术加空肠造瘘术 (3例 )。所有患者 (包括 1例食管镜下仅见裂隙穿孔 ,未发现异物者 )均采用胸腔闭式引流 ,并酌用灭滴灵、生理盐水冲洗胸腔等治疗。结果 :12例中 ,治愈 4例 (33.3% ) ,均为开胸保护胸主动脉经食管镜下取出异物者 ,其中 3例Ⅰ期修补食管穿孔 ;死亡 8例 (6 6 .7% ) ,均为行开胸食管壁切开取异物加食管“T”型管引流术等治疗者 ,其中 7例于术后 4h～ 7d死于继发性胸主动脉破裂大出血 ,1例死于脓毒血症。结论 :早期诊断 ,及时在开胸保护胸主动脉前提下 ,经食管镜在食管腔内取异物 ,Ⅰ期修补食管穿孔 ;避免切开食管壁经胸腔取异物引起食管壁的继发损伤 ,积极控制感染和防止继发性胸主动脉破裂大出血 ,是降低异物性胸段食管穿孔死亡率的关键。Objective:To explore the countermeasure to reduce fatality in patients with intrathoracic oesophageal perforation caused by foreign body.Method:Exploratory pleuracotomy were operated on all the 12 cases with intrathoracic esophageal perforation caused by foreign body. According to the different pathological morbids, one of following surgical procedures was operated: ①esophagoscopy was used to fetch the foreign body and the oesophageal perforation was repaired (3 cases),②esophagotomy was adopted to fetch the foreign body and to had the oesophageal a drainage using 'T' tube (5 cases),③ esophagotomy was adopted to fetch the foreign body and to had the oesophageal a drainage using 'T' tube as well jejunostomy (3 cases). Occlusive drainage were used on all the cases and pleuroclysis with flagyl soloution and normal saline were used on some cases.Result:Four of 12 cases ( 33.3 %) were cured, the others ( 66.7 %) died, among them 7 cases died of breaks of thoracaorta and hematorrhoea afterwards .Conclusion:An esophagoscopy to fetch the foreign body, the pleuracotomy to protect thoracaorta in time, preventing infection and hematorrhoea post-operation are keys in reduce the fatality in patients with intrathoracic oesophageal perforation caused by foreign body.

关 键 词：异物 食管穿孔 外科手术 

分 类 号：R649.4[医药卫生—外科学]