| 摘要: |
| ［摘要］ 目的 总结自发性食管破裂(Boerhaave 综合征) 的诊断和治疗经验,降低病死率。方法 1990-02～2010-12共收治7例由基层医院以液气胸或脓气胸诊断行胸腔闭式引流后转诊患者。所有病例入院后继续行胸腔闭式引流，根据病史、体征及胸腔引流瓶内液体的性状，初步考虑为自发性食管破裂，然后急诊行胸部CT、电子胃镜检查，口服美蓝后根据胸腔引流液的性状得以明确诊断。确诊后均禁食、胃肠减压、抗感染、营养支持、纠正水电解质紊乱及维持酸碱平衡等。急诊手术6例，继续行患侧单纯胸腔闭式引流及支持对症治疗1例。结果 施行急诊手术的6例患者均手术成功，无肺部感染、肺不张、脓胸、食管胸膜瘘、呼吸功能衰竭和心功能衰竭等并发症发生，术后复查胸片显示肺部膨胀良好；施行保守治疗的1例患者，因感染性休克于第5天死亡。结论 尽快做出诊断,早期胸腔闭式引流,及时开胸手术修补、术后充分引流和营养支持是提高治愈率的关键。 |
| 关键词: 自发性食管破裂 诊断 外科治疗 |
| DOI：10.3969/j.issn.1674-3806.2011.08.20 |
| 分类号:R 571 |
| 基金项目: |
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| Diagnosis and surgical treatment of Boerhaave syndrome:Report of 7 cases |
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HUANG Xi-feng, WEI Ming, LIAO Yong, et al.
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Department of Thoracic Surgery,Guangxi Longtan Hospital, Liuzhou 545005, China
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| Abstract: |
| ［Abstract］ Objective To summarized the experience of diagnosis and surgical treatment of Boerhaave syndrome, reduce death rate. Methods From Feb. 1990 to Dec. 2010, seven patients were diagnosed as hydropneumothorax or pyopneumothorax in primary hospital, and all patients were performed thoracic closed drainage in primary hospital. After the patients were transferred to our hospital, all patients received continued thoracic closed drainage. According to the history, signs and character of drainage liquid, Boerhaave syndrome was initially considered, then Boerhaave syndrome were identified by emergency chest CT, e-gastroscopy examination and the drainage liquid stained blue after oral blue. Managements after diagnosis included of fasting, gastrointestinal decompression, antibiotics, nutritional support, correct water-electrolyte disturbance and maintain acid-base balance in all patients. Six patients received emergency operation and one patient received continued thoracic closed drainage and supportive therapy. Results In six patients who received emergency operations the operations were successful. No postoperative complications such as pneumonia, atelectasis, empyema, esophageal fistula, respiratory failure and heart failure occurred. Postoprative X-ray examination showed lung expansion were better. One patient who received conservative therapy died of septic shock on 5 days after onset. Conclusion Making a diagnosis as soon as possible, early closed thoracic drainage, thotacic surgical repair in timely, postoperative adequate drainage and nutritional support, all these are the key to improve cure rate. |
| Key words: Boerhaave syndrome Diagnosis Surgical treatment |
