摘要
目的:探讨外科治疗延迟诊断的晚期自发性食管破裂合并脓胸的价值。方法:回顾性分析2007年9月至2010年5月南方医科大学珠江医院收治的3例晚期自发性食管破裂患者的临床资料,明确诊断后行剖胸探查及脓胸廓清术,1例患者予带蒂肋间肌瓣修复,2例未做修补,术中同期行空肠造瘘。术后予呼吸机辅助呼吸、持续胸腔冲洗及引流、肠内外营养支持等处理。结果:3例患者手术过程顺利,无手术死亡;手术时间180～270 min,平均手术时间210 min;术后无脓胸、肺部感染等明显并发症;住院时间35～76 d,平均住院时间37 d。平均随访时间1.5年,患者无食管狭窄、反流性食管炎发生,日常工作和生活正常。结论:对延误诊断的晚期自发性食管破裂,手术的指征应尽量放宽,只要患者全身情况许可,应强调尽早外科手术治疗。
Objective： To explore the clinical value of surgical treatment for late-diagnosed spontaneous esophageal with empyema. Methods： A retrospective analysis was performed on the clinical data of 3 late- diagnosed cases of spontaneous rupture of esophagus registered to Nanfang University Zhujiang Hospital between September 2007 and May 2010. All the patients underwent exploratory thoractomy and pyemectomy following a confirmed diagnosis. Surgical repair of the esophageal rupture was completed in one patient with intercostal peclicled muscle flap, but was not given to the other two patients. Jejunostomy was concurrently perf＇onued after the thoracic procedures in all patients. Postoperative treatment included mechanical ventilation, continuous pleural lavage and drainage, enteral and parenteral nutrition, gastric tube and mediastinum drainage. Results： In all the patients, surgical procedures were uneventful. There was no operative mortality. The operative time was 180 to 270 rain （mean： 210 rain）. No major complications, such as empyema and pulmonary infection, were reported after surgery. The median length of hospital stay was 37 days. During the follow-up for a mean of 1.5 years, none of the patients developed esophageal stenosis and gastroesophageal reflux or any limitations to social activities and daily life. Conclusion： If physical condition permits, surgical indications for late-diagnosed spontaneous esophageal rupture can be properly broadened, and the patients should be aggressively attempted for surgical treatment.
出处
《广州医学院学报》
2011年第6期31-34,共4页
Academic Journal of Guangzhou Medical College
关键词
自发性食管破裂
脓胸
晚期
手术治疗
spontaneous esophageal rupture
empyema
late stage
surgical treatment
