晚期自发性食管破裂治疗方法探析.docVIP

晚期自发性食管破裂治疗方法探析【摘要】 目的 探讨晚期自发性食管破裂的治疗方法。方法 回顾性分析本院1997年1月至2008年12月22例晚期自发性食管破裂患者的治疗方法,8例患者选用食管内支架置入,13例作剖胸探查、食管裂口带蒂膈肌瓣修复,1例仅作胸腔引流及肠道营养支持。结果 全组治愈18例,治愈率81.8%,死亡4例,死亡率18.2%。8例患者食管内支架置入,治愈率87.5%,其中1例并发支架下滑移位,经更换支架后30 d治愈出院,另1例因支架造成严重的食管瘘及胸腔感染死亡,其余6例患者术后无明显并发症,平均住院29 d治愈出院。13例剖胸手术患者,治愈率84.6%,术后2例出现严重食管瘘及胸腔感染,并因多脏器功能衰竭死亡,其余11例患者无严重并发症,平均住院38天治愈出院。1例仅作胸腔引流、肠道营养支持患者因胸腔感染出现多器官功能衰竭死亡。结论 晚期自发食管破裂患者应该积极治疗,食管内支架置入或剖胸探查、食管裂口带蒂膈肌瓣修复,是可以选择的方法,但选择哪一种治疗方法更为合适,应该因病情、病变部位以及临床经验等具体情况而定。 【关键词】 自发性食管破裂;晚期;手术治疗;带蒂膈肌瓣;食管内支架 The approach of 22 cases of spontaneous rupture of esophagus in advanced stage CAI Xu-dong,LIN Shan-chang,LIU Dai-xuan,et al. Cardiac-thoracic department,the Second Affiliated Hospital of Fujian Medical University,Quanzhou 362000,China 【Abstract】 Objective To analyze the approach of 22 cases of spontaneous rupture of esophagus in advanced stage.Methods Retrospective analysis of the approach of 22 cases of spontaneous rupture of esophagus in advanced stage from January in 1997 to December in 2008, 8 of which adopted esophageal stents, 13 of chich were treated by exploratory thoracotomy and the splits were repaired by disphragmatic muscle flap with pedicle.Another case was treated only by thoracic close drainage and enteral nutritional support. Results In the group,18 cases were cured and recovery rate was 81.8%,while 4 cases were dead and death rate was 18.2%.The recovery rate was 87.5% in the 8 cases of esophageal stent treatment,1 of which complicating stent shift was replaced by another new esophageal stent and cured 30 days later,1 died of esophageal fistula and serious thoracic infection induced by stent injury, another 6 were cured without any serious complication, averagely 29 days in hospital.And the recovery rate was 84.6% in the 13 cases of exploratory thoracotomy,2 of which died of multiple organ failure caused by esophageal fistula and serious thoracic infection,another 11 cases were cured without any serious complication, averagely 38 days in hos