食管穿孔和破裂33例临床分析

目的：总结食管穿孔和破裂的诊断及处理方法的经验。方法：对2000年—2010年收治的33例食管穿孔和破裂患者临床资料进行回顾分析。结果：食管穿孔和破裂的病因为异物性18例（55%）、医源性6例（18%）、自发性7例（21%）、外伤性2例（6%）。主要症状为食管穿孔部位疼痛30例（90.9%）、气促或呼吸困难15例（45.5%）、吞咽困难12例（36.4%）、发热12例（36.4%）、恶心或呕吐5例（15.2%）、呕血3例（9.1%）。保守治疗6例,手术治疗27例。治愈25例,死亡2例（自杀1例）。手术治疗组死亡1例（1/27,3.7%）,保守治疗组死亡1例（1/6,16.7%）。即刻治疗组住院死亡0例（0/7）,早期治疗组住院死亡0例（0/7）,晚期治疗组住院死亡2例（2/19）。术后并发症：食管瘘4例,急性呼吸功能不全2例,脓胸合并肺不张3例。结论：早期诊断、选择合适的辅助检查、早期治疗、根据病情个性化治疗、选择合适的治疗方法,是提高本病治愈率,降低病死率的关键。

Diagnosis and Treatment of Esophageal Perforation and Disruption 33 Cases Report

Objective：To summarize the experience of diagnosis and management for esophageal perforation and disruption.Methods：From 2000 to 2010,the clinical data of 33 patients with esophageal perforation were analyzed retrospectively.Results：The causes of perforation were foreign bodies（n=18）,iatrogenic（n=6）,spontaneous（n=7）,and traumatic（n=2）.The most frequent symptoms were pain（n=30）,dyspnea（n=15）,dysphagia（n=12）,fever（n=12）,and vomiting（n=5）,hematemesis（n=3）.Operation was performed in 27 cases,and conservative treatment in 6 cases.Treatment results revealed cure in 25 patients,death in 2 patients and 1 patient committed suicide.The mortality of patients with esophageal perforation is 3.7% in the surgery group,16.7% in the conservatively managed group.The hospital mortality rate was lower for the patients with early diagnosis and treatment than for those who had a treatment delay exceeding 24 h.The postoperative complications were esophageal leakage（n=4）,respiratory failure（n=2）,pyothorax and atelectasis（n=3）.Conclutions：In order to increase the recovery rates and decrease the mortality,it is important to diagnose and treat the disease in it′s early phases,and the treatment method was chosen on an individual basis.