摘要
目的探讨自发性食管破裂的临床特征、诊断和治疗方法,以提高临床诊治水平。方法回顾性分析自1996年1月至2010年6月苏北人民医院收治34例自发性食管破裂患者的相关临床资料,其中男28例,女6例;平均年龄57.6(32～80)岁。主要临床症状为呕吐后出现胸腹剧烈疼痛、发热、呼吸困难和休克等,从发病到确诊时间4 h～7 d。保守治疗13例,均采用胸腔闭式引流,并行逆行胃肠减压和空肠造瘘营养支持;食管修补术治疗21例,手术为食管裂口分层吻合,同时行空肠造瘘及逆行胃肠减压。结果全组无死亡,均治愈出院。经保守治疗的13例患者平均住院时间为46 d,行食管修补术的21例患者平均住院时间为17 d,术后破裂口均一期愈合。34例患者随访l～8年,失访4例;经保守治疗的患者中随访11例,手术治疗的患者中随访19例,随访期间均能正常饮食,无食管狭窄、反流性食管炎及慢性脓胸等症状。结论自发性食管破裂是一种误诊率和病死率均较高的胸外科急症,早期诊断和尽早手术闭合破裂口和通畅引流是治疗的关键。
Objective To investigate clinical characteristics,diagnosis,and treatment for patients with spontaneous esophageal rupture,and improve clinical diagnostic and treatment level.Methods We retrospectively analyzed the clinical data of 34 patients with spontaneous esophageal rupture who were treated in Subei People＇s Hospital from January 1996 to June 2010.There were 28 male patients and 6 female patients with their age ranging from 32 to 80 years old（mean 57.6 years old）.Main clinical manifestations included severe chest and abdominal pain after vomiting,fever,dyspnea and shock.The duration between disease onset and establishing diagnosis ranged from 4 hours to 7 days.Thirteen patients received conservative treatment including chest drainage,retrograde gastrointestinal decompression and enteral nutrition through jejunostomy.Twenty one patients received surgical treatment including layered anastomosis of the ruptured esophagus,retrograde gastrointestinal decompression and enteral nutrition through jejunostomy.Results All the patients were cured without in-hospital death.The mean hospital stay of the 13 patients who received conservative treatment was 46 days,while that of the 21 patients who received surgical treatment was 17 days.All the ruptured esophagus were one-stage healed.All the 34 patients were followed up from l to 8 years,including 11 patients in the conservative treatment group and 19 patients in the surgical treatment group,but 4 patients was lost during follow-up.All the patients had a normal diet without symptoms of esophageal stricture,reflux esophagitis or chronic thoracic empyema.Conclusion Spontaneous esophageal rupture is a thoracic emergency with a high misdiagnosis rate and mortality.Early diagnosis,early surgical repair of ruptured esophagus and satisfactory chest drainage play a vital role in the treatment for patients with spontaneous rupture of esophagus.
出处
《中国胸心血管外科临床杂志》
CAS
2012年第5期476-478,共3页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
自发性食管破裂
诊断
治疗
布尔哈夫综合征
Spontaneous esophageal rupture
Diagnosis
Treatment
Boerhaave＇s syndrome
