摘要
目的探讨自发性食管破裂的治疗方法,总结其外科治疗经验。方法回顾性分析华西医院1998年1月至2011年12月14例自发性食管破裂患者的临床资料,其中男11例,女3例;年龄(55.2±14.4)岁;发病时间(49.6±21.2)h。行Ⅰ期修补术11例,消化道重建术1例,安置可取出式食管带膜支架1例;行床旁胸腔闭式引流术1例。结果 13例患者行手术治疗,总体治愈率84.6%(11/13)。行Ⅰ期修补术11例中8例(72.7%)治愈,术后发生瘘3例,其中2例死亡,另1例治愈,住院时间(22.3±7.0)d。行消化道重建术和安置可取出式食管带膜支架的2例均痊愈,住院时间(39.0±5.7)d。1例仅行床旁胸腔闭式引流术,住院10 d后死亡。结论积极的外科治疗是自发性食管破裂的有效方法,发病时间超过24 h仍可依据术中情况行Ⅰ期修补术,无Ⅰ期修补指征者可以行消化道重建术、安置带膜食管支架或食管腔内置管术。
Objective To summarize our experience of surgical treatment of Boerhaave＇s Syndrome.Methods We retrospectively analyzed clinical records of 14 patients with Boerhaave＇s syndrome in West China Hospital between January 1998 and December 2011.There were 11 male patients and 3 female patients with a mean age of 55.2±14.4 years and mean time interval between onset and admission of 49.6±21.2 h.Primary repair was performed in 11 patients.Esophagectomy and reconstruction of digestive track was performed in 1 patient and intra-luminal stent implantation was applied in 1 patient.Intercostal catheter insertion was performed in 1 patient.Results Thirteen patients underwent surgical therapy,and their survival rate was 84.6%（11/13）.Among the eleven patients who underwent primary repair,8 patients（72.7%）were cured and 3 patients experienced postoperative leakage resulting 2 deaths.The other one patient was cured with in-hospital time of 22.3±7.0 d.Two patients underwent digestive track reconstruction and intra-luminal stent implantation respectively and all survived with in-hospital time 39.0±5.7 d.Another patient underwent bedside chest drainage and died 10 d after admission.Conclusion Aggressive surgical management is an effective way to treat Boerhaave＇s syndrome,and primary repair can lead to ideal prognosis in delayed patients whose time interval between onset and admission is beyond 24 h.Digestive track reconstruction and intra-luminal stent implantation are alternative methods on condition that primary repair can not be accomplished.
出处
《中国胸心血管外科临床杂志》
CAS
2012年第5期472-475,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
自发性食管破裂
诊断
外科治疗
Ⅰ期修补术
Boerhaave＇s syndrome
Diagnosis
Surgical treatment
Primary repair
