食管穿孔急诊处理原则及治疗方式的探讨

目的：探讨食管穿孔外科急诊处理原则、把握最佳治疗时机及选择合理的治疗方式。方法：回顾总结分析厦门大学附属中山医院胸外科和华中科技大学同济医学院附属协和医院胸外科1997年3月-2008年3月外科治疗食管穿孔33例。治疗禁食观察1例；单纯食管修补4例；食管修补加纵隔胸腔引流6例；食管修补加带蒂大网膜填塞包绕2例；空肠双管造瘘加纵隔胸腔引流13例；食管切除胃食管吻合水3例（其中1例为食管修补失败者）；置入食管支架1例；食管气管瘘切除修补1例；食管瘘口修补并肺叶切除1例；食管-主动脉瘘放弃治疗1例。结果：治愈23例，好转8例，死亡2例。结论：食管破裂穿孔急诊处理原则是闭合瘘口、控制感染、营养支持，其治疗方式根据食管穿孔时间、原因、部位、纵隔及胸腔感染等具体情况选择合理、有效、个体化的治疗方式。

Study on emergency therapeutic principle and treatment of esophageal perforation

Objective:To explore the emergency therapeutic principle, optimization opportunity and suitable treatment of esophageal perforation. Methods: Clinical data of 33 esophageal perforation patients who were treated in thoracic surgery department of Zhongshan affiliated Hospital or Affiliated Union Hospital of Tongji Medical College, from March 1997 to March 2006 were retrospectively analyzed. Managements included abrosia and observation in 1 case, primary repair of esophageal perforation in 4 cases, primary repair with mediastinal and chest drainage in 6 cases, primary repair with vaso-epiploica in 2 cases, two-tube of jejunostomy with mediastinal and chest drainage in 13 cases, esophagectomy and esophagogastrostomy in 3 cases( including failure of primary repair in 1 case), esophageal stent implantation in 1case, repair of tracheoesophageal fistula in 1case, repair of tracheoesophageal fistula with lung lobectomy in 1case, 1 case of tracheoesophageal fistula abandoned treatment. Results:Post-operative results revealed cure in 23 cases, improvement in 8 and death in 2 cases. Conclusion: The emergency therapeutic principle of esophageal perforation are blocking esophageal disrupture, anti-infection and nutritional support. The suitable, effective and individual therapeutic pattern should be selected according to the duration, cause, location of esophageal perforation and the situation of mediastinum and chest infection.