食管破裂的特征及外科治疗

目的 总结食管破裂的临床特征和治疗经验，从而提高对该病的诊断和治疗水平。方法 分析我科从1954年至今共收治食管破裂62例临床资料。62例均经上消化道碘油造影，纤维食管镜检查，胸部X线或CT检查证实。其中自发性食管破裂11例，食管异物所致15例，外伤性2例，医源性损伤34例。手术治疗48例，其中食管修补43例，食管部分切除、胃或结肠代食管5例。空肠造瘘术、胸腔闭式引流和／或纵隔引流治疗14例。结果 误诊9例(14．5％)。治愈58例，死亡4例。结论 提高对本病的认识，详细询问病史及查体，口服亚甲蓝后胸穿或胃镜检查有助诊断和减少误诊。积极手术治疗，慎重选择保守治疗。不能一期手术修补者，充分引流可使病人有好的转归。

Clinical characteristics and surgical treatment of esophageal injury

Objective To summarize the clinical characteristics and surgical treatment of esophageal injury, in order to improve the veracity of diagnosis and efficiency of treatment. Methods Sixty two cases with esophageal injury admitted in our hospital since 1962 were retrospectively studied. There were spontaneous esophageal rupture in 11 cases,perforation of esophageal caused by foreign body in 15 cases,iatrogenic esophageal rupture in 34 cases and traumatic esophageal rupture in 2 cases. The diagnosis was made by iodolography of esophagus,esophagoscopy and teleroentgenogram of chest. Results There were 9 cases of mis diagnosis (14.5%) and 4 deaths. Forty eight cases underwent surgical treatment. Repair of esophagus was performed in 43 cases and esophagectomy in 5 cases. The length of the rupture ranged from 3cm to 12 cm,and the rupture occured in all parts of esophagus. Fourteen cases underwent conservative treatment,including jejunostomy,thoracic or/and mediastinal drainage. Conclusion Esophageal injury can easily be mis diagnosed,so it is necessary to perform all round examination and it is helpful to use methylene blue in suspicious cases. Surgical treatment is effective and conservative treatment should be considered deliberatively. If the rupture could not be closed by operation,then adequate drainage is necessary for a good outcome to the patient.