Landen S, El Nakadi I
Department of Surgery, St. Elisabeth Hospital, Avenue De Fré 206, 1180 Brussels, Belgium.
Surg Endosc. 2002 Sep;16(9):1354-7. doi: 10.1007/s00464-001-9185-4. Epub 2002 May 23.
Boerhaave's syndrome requires urgent thoracotomy, laparotomy, or both for esophageal repair and pleuromediastinal debridement. Minimally invasive techniques may be suitable alternatives.
Over a period of 12 months, three patients with spontaneous esophageal perforations after forceful vomiting were treated by a combination of minimally invasive techniques including laparoscopy, thoracoscopy, mediastinoscopy, and endoscopic stenting.
Esophageal repair was performed transhiatally via laparoscopy using primary suture, primary suture reinforced by a fundic patch, and fundic patch alone in one patient each. One patient had a second perforation of the proximal esophagus, which was sutured through a cervical incision. This patient successfully underwent secondary endoscopic stenting for a persistent esophageal fistula. Mediastinal debridement was performed transhiatally and also by means of a mediastinoscope introduced via the cervical incision in one patient. One patient required secondary thoracoscopic debridement of a pleural empyema but died of sepsis after 1 month. The two other patients recovered and were discharged from the hospital after 2 and 8 weeks, respectively.
Boerhaave's syndrome is amenable to minimally invasive techniques. Avoidance of a formal thoracotomy with its resulting morbidity could be of considerable benefit to these critically ill patients.
Boerhaave综合征需要紧急开胸手术、剖腹手术或两者同时进行，以修复食管并进行胸膜纵隔清创。微创技术可能是合适的替代方法。
在12个月的时间里，对3例因剧烈呕吐后自发性食管穿孔的患者采用了包括腹腔镜检查、胸腔镜检查、纵隔镜检查和内镜支架置入术在内的微创技术联合治疗。
1例患者经腹腔镜经裂孔进行食管修复，分别采用一期缝合、胃底补片加强一期缝合和单纯胃底补片。1例患者近端食管出现二次穿孔，通过颈部切口进行缝合。该患者因持续性食管瘘成功接受了二次内镜支架置入术。1例患者经裂孔进行纵隔清创，另1例患者通过颈部切口置入纵隔镜进行纵隔清创。1例患者因胸腔积脓需要二次胸腔镜清创，但1个月后死于败血症。另外2例患者康复，分别在2周和8周后出院。
Boerhaave综合征适合采用微创技术。避免进行有较高发病率的正规开胸手术可能对这些重症患者有很大益处。
