手术一期修补成人自发性食管破裂46例

摘要

目的 探讨成人自发性食管破裂的手术治疗效果.方法 统计2007年3月至2017年3月山西医科大学第一医院心胸外科收治46例成人自发性食管破裂患者,急诊行开胸探查食管破裂修补术.破裂12h内手术行单纯破裂修补术,破裂>12h行破裂修补+带蒂膈肌瓣覆盖加强.结果 一期愈合比例89%(41/46),术后瘘发生比例11%(5/46).发生术后食管瘘者,经积极的抗炎、胸腔引流、支持治疗均治愈.全组无死亡病例.结论 早期诊断及周密的治疗计划与实施是改善自发性食管破裂预后的关键.外科积极一期单纯修补破口(12h内)或破口修补+带蒂膈肌瓣覆盖加强(大于12h)安全可行,可以推广.%Objective To investigate the effect of surgical treatment of spontaneous esophageal rupture in a-dults.Methods Forty-six cases of patients with spontaneous rupture of esophagus who underwent emergency tho-racotomy to repair esophageal rupture from March 2007 to March 2017 in the Department of Cardiothoracic Sur-gery of the First Hospital of Shanxi Medical University were retrospectively analyzed.The patients within 12 hours after rupture were repaired with simple repair,and the patients more than 12 hours were repaired with sim-ple repair and strengthening with diaphragmatic muscle flap with pedicle.Results The primary healing rate was 89%(41/46),and the incidence of postoperative fistula was 11%(5/46),which were cured by active anti-inflam-matory,pleural drainage and supportive therapy finally.There was no dead case.Conclusion Early diagnosis and careful treatment planning and implementation are the keys to improve the prognosis of spontaneous rupture of e-sophagus.Surgical treatment of simple repair for the break(within 12 hours)or simple repair + diaphragmatic muscle flap with pedicle for the break(more than 12 hours)is safe and feasible,which can be promoted.