自发性食管破裂的诊治体会

目的探讨自发性食管破裂的诊断及治疗方法,以提高对该病的认识。方法对该院自1998年3月～2006年7月以来收治的4例自发性食管破裂的诊断和治疗方法进行回顾性分析。结果4例患者来该科时病程均超过24h,失去一期食管缝合修补的手术时机,3例采用胸腔闭式引流、灌洗,2周后纤维板形成,适时切开,改为开放引流;1例外院转来时纤维板已形成,直接行胸壁全层切开,开放引流。3例患者住院3～5个月后康复出院,1例中途放弃治疗,自动出院。结论应提高对自发性食管破裂的认识,避免误诊;适时行胸壁全层切开,使脓腔完全敞开引流,清除胸腔污染物和脓性渗出物;合并应用敏感的抗生素,加强全身营养支持治疗。

Experience in diagnosis and treatment for spontaneous rupture of esophagus

Objective] To study the diagnosis and treatment for spontaneous rupture of esophagus, in order to further explore this disease. Method] 4 cases admitted to our hospital from March 1998 to July 2006 were retrospectively analyzed. Results] All the 4 cases took more than 24 hours to get to our hospital and consequently missed the first stage of esophagus surgical repair. In 3 cases, we adopted drainage and lavage of pleural cavity, and when the fiber board was firmed after 2 weeks, we adopted open drainage. 1 case was adopted with open drainage as the fiber board had already been formed before transferred to our hospital. 3 patients recovered after 3 to 5 months, and 1 gave up treatment. Conclusion] Key factors of improving operation and reducing operation time are: being familiar with the disease to avoid misdiagnosis; Open drainage shall be adopted at right time to clean pleural cavit; Joint use of antibiotics and improving body nutritional support treatment.