[经典]晚期自发性食管破裂治疗方法探讨

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1、［经典］晚期自发性食管破裂治疗方法探讨晩期自发性食管破裂治疗方法探讨【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%o8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痿及胸腔感染死亡，其余6例患者

2、术后无明显并发症，平均住院29d治愈出院。13例剖胸手术患者,治愈率84.6%,术后2例出现严重食管痿及胸腔感染，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。结论晩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Theapproa

3、chof22casesofspontaneousruptureofesophagusinadvaneedstageCAIXu~dong,LINShan-chang,LIUDai-xuan,etal.Cardiac-thoracicdepartment,theSecondAffiliatedHospitalofFujianMedicalUniversity,Quanzhou362000,Chins[Abstract]ObjectiveToanalyzetheapproachof22casesofspontaneousru

4、ptureofesophagusinadvancedstage・MethodsRetrospectiveanalysisoftheapproachof22casesofspontaneousruptureofesophagusinadvancedstagefromJanuaryin1997toDecemberin2008,8ofwhichadoptedesophagealstents,13ofchichweretreatedbyexploratorythoracotomyandthesplitswererepaired

5、bydisphragmaticmuscleflapwithpedicle.Anothercasewastreatedonlybythoracicclosedrainageandenteralnutritionalsupport・ResultsInthegroup,18caseswerecuredandrecoveryratewas81.8%,while4casesweredeadanddeathratewas18.2%.Therecoveryratewas87.5%inthe8casesofesophagealsten

6、ttreatment,1ofwhichcomplicatingstentshiftwasreplacedbyanothernewesophagealstentandcured30dayslater,1diedofesophagealfistulaandseriousthoracicinfectioninducedbystentinjury,another6werecuredwithoutanyseriouscomplication,averagely29daysinhospita1.Andtherecoveryrate

7、was84.6%inthe13casesofexploratorythoracotomy,2ofwhichdiedofmultipleorganfailurecausedbyesophagealfistulaandseriousthoracicinfection,another11caseswerecuredwithoutanyseriouscomplication,averagely38daysinhospita1.Thepatienttreatedonlybythoracicclosedrainageandente

8、ralnutritionalsupportdiedofmultipleorganfailurecausedbyseriousthoracicinfection.ConclusionPatientsofspontaneousruptureofesophagusinadvancedstageshouldbeactivelytreate