10例自发性食管破裂临床诊治分析
Clinical diagnosis and treatment of 10 cases with spontaneous esophageal rupture
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摘要: 目的 探讨自发性食管破裂的临床诊治经验,提高一线临床医师对该疾病的认识。 方法 选取2015年1月- 2017年2月在我院急诊科及胸外科治疗的确诊为自发性食管破裂的10例患者,回顾性分析其临床特点和治疗方案。 结果 10例患者经食管造影CT及胃镜检查确诊为食管破裂穿孔,其中8例患者食管破口< 5 cm,破口相对规则,周围组织水肿较轻,确诊后24 h内转胸外科手术,术后给予禁食水,留置空肠营养管,抗感染及对症支持治疗治愈。1例患者死亡,为56岁男性,既往食管憩室,发病至就诊时间超过48 h,食管破口5 cm,食管破裂后合并胸主动脉破裂,上消化道出血,行主动脉+食管覆膜支架置入术,胸腔闭式引流灌洗,空肠营养管营养支持等治疗后早期病情稳定,1个月后出现食管支架处食管瘘,导致纵隔感染加重,最终死于多器官功能衰竭。1例69岁女性,既往糖尿病,入院时胸闷发热伴呼吸困难,气管插管,机械通气,外院转入至发病第19日确诊食管破裂,破口> 5 cm,周围组织水肿严重,食管破裂合并严重纵隔、胸腔感染,住院期间长时间高热,后期出现脓毒症休克,家属放弃治疗转回当地医院。 结论 食管破裂是临床危急重症,尽早明确诊断和选择适宜的外科手术方式是获得良好治疗效果的关键。合并严重纵隔感染,多脏器衰竭的患者预后差,死亡率高。Abstract: Objective To review the experience of clinical diagnosis and treatment of spontaneous esophageal rupture, and improve clinicians' understandings of this disease. Methods Ten patients diagnosed as spontaneous esophageal rupture in emergency department or thoracic surgery department of our hospital from January 2015 to February 2017 were selected, and their clinical characteristics and treatment plans were retrospectively analyzed. Results All patients with esophageal rupture perforation were diagnosed by esophageal computed tomography (CT) imaging and gastroscopy, 8 cases of whom with relatively neat esophageal crevasse< 5 cm, and lighter edema of surrounding tissues. Patients underwent thoracic surgery within 24 h after diagnosis, and
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