自发性食管破裂的早期诊断和外科治疗

目的：探讨自发性食管破裂临床症状、诊断、鉴别诊断和外科治疗，以提高临床诊治水平。方法：回顾性分析16例自发性食管破裂患者的相关临床资料，并结合文献进行分析。结果：16例均男性；年龄17～59岁，平均年龄46．4岁；全部为胸段食管破裂，食管中段3例、下段13例，破入左胸6例，右胸10例，破裂长度为O．5—6em，平均2，54em；主要症状为剧烈胸腹疼痛、发热、呼吸困难及休克等，查体可见液气胸，部分患者可见皮下气肿。全组24h内修补2例，1例48h内行一期修补，用纵隔胸膜覆盖，放置纵隔引流管，5例在感染控制后行破裂段食管切除、胃一食管吻合术全部治愈；保守治疗7例，1例于发病后第3d并发胸膜腔出血行手术止血后放置纵隔引流管，进一步行食管支架植入术2月后破口愈合，余治愈及死亡各3例。结论早期诊断及尽早手术闭合破裂1：2和通畅引流是治疗的关键。进行胸膜腔穿刺、上消化道造影等检查可帮助诊断。

Early Diagnosis and Surgical Treatment of Spontaneous Esophageal Rupture

Objective To explore clinical characteristics, diagnosis,differential diagnosis,and surgical treatment of spontaneous esophageal rupture.And thereby to improve the level of clinical diagnosis and treatment.Methods Clinical data of 16 patients with spontaneous esophageal rupture were analyzed retrospectively and the literatures were reviewed.Results 16 patients were all male.Their age were ranged from 17 to 59 year old(mean 46.4 year old).Ruptured location were all in thoracic esophagus.3 patients were in mi...