食管穿孔和破裂的诊断与治疗

目的 提高对食管穿孔和破裂的诊断及处理水平。方法 回顾性分析经外科处理的45例食管穿孔或破裂患的临床资料。结果 本组患经胸部平片、胸腔穿刺、上消化道造影及胃镜确诊。15例为自发性食管破裂，6例为医源性穿孔，5例为创伤性穿孔，10例为食管癌并食管支气管瘘，9例为食管憩室并食管支气管瘘。治疗予以食管修补9例；胸腔引流、空肠造瘘9例(其中1例为食管修补失败后改行此手术)；食管切除胃食管吻合术12例(其中3例为食管修补失败)；胃造瘘术4例；置入食管支架4例；食管支气管瘘切除修补3例；食管瘘口修补并肺叶切除2例；食管胃弓上短路1例，颈部引流2例；放弃治疗3例。治愈25例，好转11例，死亡6例。结论 详细了解病史和进行胸腔穿刺、上消化道造影等检查可帮助诊断。尽早手术闭合瘘口和治疗食管原发病变是治疗的关键。

Diagnosis and treatment of esophageal perforation and disruption

Objective To improve the diagnosis and management of esophageal perforation and disruption. Methods Forty five cases of esophageal perforation or rupture were treated with surgical intervention and clinical data were analyzed retrospectively. Results Diagnosis was confirmed in all patients by chest X-rays, thoracentesis, barium meal examination and endoscopy. In this series, there were 15 cases of spontaneous esophageal disruption, 6 of iatrogenic esophageal perforation, 5 of traumatic perforation, 10 of advanced esophageal carcinoma with esophago-bronchial fistula, and 9 of esophageal diverticulum with esophago-bronchial fistula. Managements included primary repair of esophageal perforation in 9 cases, chest drainage and jejanostomy in 9 including one with failure of primary repair, esophagoectomy and esophagogastro-anastomosis in 12 including 3 with failure of primary repair, gastrostomy in 4, the covered expandable metal stent in 4, repair of esophago-bronchial fistula in 3, repair of esophago-bronchial fistula with lung lobectomy in 2, super-aortic arch esophago-gastmmy bypass in 1, cervicular drainage in 2. 3 patients abandoned treatment. Postoperative results revealed cure in 25 patients, improvement in 11 and death in 6. Conclusions Complete collection of medical history, thoracentesis and esophageal roentgenograms are very helpful for the diagnosis. Surgical closure of esophageal perforation as soon as possible and effective management of the primary esophageal lesion are the successful keys to the treatment of esophageal perforation or disruption.