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1、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30d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29d
2、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Theapproachof22casesof
3、spontaneousrupture11ofesophagusinadvancedstageCAIXu-dong,LINShan-chang,LIUDai-xuan,etal.Cardiac-thoracicdepartment,theSecondAffiliatedHospitalofFujianMedicalUniversity,Quanzhou362000,China【Abstract】ObjectiveToanalyzetheapproachof22casesofspontaneousruptureofe
4、sophagusinadvancedstage.MethodsRetrospectiveanalysisoftheapproachof22casesofspontaneousruptureofesophagusinadvancedstagefromJanuaryin1997toDecemberin2008,8ofwhichadoptedesophagealstents,13ofchichweretreatedbyexploratorythoracotomyandthesplitswererepairedbydis
5、phragmaticmuscleflapwithpedicle.Anothercasewastreatedonlybythoracicclosedrainageandenteralnutritionalsupport.ResultsInthegroup,18caseswerecuredandrecoveryratewas81.8%,while4casesweredeadanddeathratewas18.2%.Therecoveryratewas87.5%inthe8casesofesophagealstentt
6、reatment,1ofwhichcomplicatingstentshiftwasreplacedbyanothernewesophagealstentandcured30dayslater,1diedofesophageal11fistulaandseriousthoracicinfectioninducedbystentinjury,another6werecuredwithoutanyseriouscomplication,averagely29daysinhospital.Andtherecoveryr
7、atewas84.6%inthe13casesofexploratorythoracotomy,2ofwhichdiedofmultipleorganfailurecausedbyesophagealfistulaandseriousthoracicinfection,another11caseswerecuredwithoutanyseriouscomplication,averagely38daysinhospital.Thepatienttreatedonlybythoracicclosedrainagea
8、ndenteralnutritionalsupportdiedofmultipleorganfailurecausedbyseriousthoracicinfection.ConclusionPatientsofspontaneousruptureofesophagusinadvancedstageshouldbeactivelytreatedbyesophagealst
