摘要
Abstract
Objective To review the experience of clinical diagnosis and treatment of spontaneous esophageal rupture,and improve clinicians' understandings of this disease.Methods Ten patients diagnosed as spontaneous esophageal rupture in emergency department or thoracic surgery department of our hospital from January 2015 to February 2017 were selected,and their clinical characteristics and treatment plans were retrospectively analyzed.Results All patients with esophageal rupture perforation were diagnosed by esophageal computed tomography (CT) imaging and gastroscopy,8 cases of whom with relatively neat esophageal crevasse ＜ 5 cm,and lighter edema of surrounding tissues.Patients underwent thoracic surgery within 24 h after diagnosis,and received postoperative fasting and enteral nutrition.Anti infection and symptomatic support treatment were performed.One 56 year-old male patient died,who had a history of esophageal diverticulum,and the time of onset to seeing a doctor was more than 48 h with esophageal crevasse of 5 cm.Thoracic aortic mpture was found after esophageal rupture with upper gastrointestinal bleeding,and aortic+esophageal stent implantation,thoracic cavity closed drainage,enteral nutrition were performed for this patient,who showed stable condition in early stage after treatment.However,esophageal fistula was found in esophageal stent at one month after treatment,which caused severe mediastinal infection,and the patient died of multiple organ failure.Another 69-year-old woman with diabetes had chest tightness,fever and dyspnea on admission received tracheal intubation and mechanical ventilation,then esophageal rupture was confirmed on the 19th day of onset after transferred to our hospital,with size of rupture ＞ 5 cm and severe edema of surrounding tissues.Then severe mediastinum and chest infection were found in this patient with long term fever during hospital stay.Later,septic shock appeared and patient's family members decided to transfered him back to a local hospital for treatment.Conclusion Esophageal rupture is a clinically critical disease,early diagnosis and appropriate surgical procedure are the key to get good therapeutic effect.The prognosis of patients with severe mediastinum infection or multiple organ failure is poor,and the mortality is high.关键词
食管破裂/自发性/闭式引流/外科手术/误诊Key words
esophageal rupture/spontaneity/closed drainage/surgery/misdiagnosis分类
医药卫生
