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題名 | Treatment of Spontaneous Esophageal Rupture: 11 Years of Experience=食道自發性破裂的治療:十一年經驗 |
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作者 | 賴吾為; 吳明和; 林木源; 曾堯麟; 邱南津; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 33:1 民89.01-02 |
頁次 | 頁14-20 |
分類號 | 416.241 |
關鍵詞 | 食道自發性破裂; Boerhaave's syndrome; Spontaneous esophageal rupture; |
語文 | 英文(English) |
中文摘要 | 當嘔吐動作不協調時,胃賁部,胃食道交接處和食道遠端容易發生傷害。成大醫院胸腔外科在過去十一年經歷過六例食道自發性破裂的病人,我們回顧這些患者的發病和治療經過,這六例患者,五例破到左側肋膜腔,一例破到右側。所有病患都接受外科手術治療,手術步驟包括開胸將食道直接兩層縫合再加或不加心包膜旁脂肪垂覆蓋,破到右側肋膜腔的患者併有尿毒症和休克,在術中死亡,術中發現如下:食道破裂傷口平均位於橫隔食道裂孔上2.3公分處。破裂長度平均為3.4公分,食道黏膜破裂的長度小於肌肉層的破裂長度,這些患者從症狀發生到進入開刀房的平均時間為25.4小時,其中三例超過24小時,這三例患者中有一位因術後癒合不良併發食道肋膜腔屢管,但在接受保守治療後,順利出院。保守治療包括抗生素治療,高靜脈營養注射,胸管引流和經食道灌洗,存活的主例患者中有四位願意配合接受術後胃食道返流的核子醫學檢查,呈陽性反應的只有一位(1/4,25%)。我們認為及時的手術縫合治療和徹底的肋膜腔,縱隔腔引流是最佳治療選擇,對初次手術失敗而造成食道肋膜腔瘦管的患者,若沒有明顯嚴重的敗血症現象,可以採用前述的保守治療,最後在我們這系列中經核醫檢查證實有胃食道返流的患者比例不高。 |
英文摘要 | Incoordination of emesis may induce injury of the gastric cardiac portion, gastroesophageal junction, and distal portion of the esophagus. In a review of six males with Boerhaave's syndrome, one ruptured site of the esophagus was on the right, and five were on the left side. They all received direct repair with or without the pericardial fat pad buttressing technique and drainage procedure. One patient who had uremia and septic shock died in the processes of exploratory thoracotomy. The location of the rent was 2.3 (1.0- 3.5) cm above the diaphragm, with a mean of 3.4 (1.5- 8.0) cm in length. The length of mucosal damage was shorter than that in the muscular layer. The mean interval between perforation and operation was 25.4 hours (three-cases > 24 hours). One of these three cases with late diagnosis had postoperative esophago-pleural fistula and was successfully treated with TPN, antibiotics, chest tube drainage, and transesophageal irrigation. The postoperative gastro-esophageal reflux could be detected by Tc-99m DTPA (Technetiumdiethylene triamine penta acetic acid) gastro-esophageal reflux study in one patient only (1/4, 25 %). We conclude that timely primary surgical repair with pleural and mediastinal drainage is the best treatment. Conservative treatment can be reserved for cases with failed primary repair but without severe toxic sign. The incidence of gastro-esophageal reflux was low in our series on the basis of Tc-99m DTPA gastroesophageal reflux test. |
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