食管转流术和旷置术在食管穿孔治疗中的作用。
The role of oesophageal diversion and exclusion in the management of oesophageal perforations.
作者信息
Rohatgi Ashish, Papanikitas Joseph, Sutcliffe Robert, Forshaw Matthew, Mason Robert
机构信息
Oesophagogastric Unit, St Thomas' Hospital, Westminister Bridge Road, London SE1 7EH, UK.
出版信息
Int J Surg. 2009 Apr;7(2):142-4. doi: 10.1016/j.ijsu.2008.12.042. Epub 2009 Jan 14.
AIM
Persistent sepsis from an oesophageal perforation has a near 100% mortality. We describe our experience with early oesophageal diversion and exclusion for patients in-extremis.
METHODS
A retrospective review of oesophageal perforations was performed between 2000 and 2007. There were five cases Boerhaaves and one case of iatrogenic perforation that required oesophageal diversion and exclusion. 4 males, 2 females with a mean age of 67.6 (58-72) years.
RESULTS
The primary procedure was performed within 24h in four patients; the other two were after 3 and 10 days. The intensive care unit (ITU) stay was a median of 25 days. Mortality rate was 50%. Median length of stay for the survivors was 60 days. Three patients underwent a successful colonic interposition in our unit after 6 months.
CONCLUSION
Exclusion and diversion procedures are required in very rare circumstances. In conditions of persistent leak and continuing sepsis or those patients not fit to undergo a major procedure they could be lifesaving if performed early. As it is a relatively easy and quick procedure it should be considered early as a 2nd line management option.
目的
食管穿孔导致的持续性脓毒症死亡率接近100%。我们描述了我们对危重症患者进行早期食管转流和旷置术的经验。
方法
对2000年至2007年间的食管穿孔病例进行回顾性研究。有5例博赫哈夫斯综合征病例和1例医源性穿孔病例需要进行食管转流和旷置术。4例男性，2例女性，平均年龄67.6（58 - 72）岁。
结果
4例患者在24小时内进行了初次手术；另外2例分别在3天和10天后进行。重症监护病房（ITU）住院时间中位数为25天。死亡率为50%。幸存者的住院时间中位数为60天。3例患者在6个月后在我们科室成功进行了结肠间置术。
结论
在非常罕见的情况下需要进行旷置和转流手术。在持续渗漏和持续脓毒症的情况下，或者对于那些不适合进行大型手术的患者，如果早期进行，这些手术可能挽救生命。由于这是一个相对简单快捷的手术，应尽早将其作为二线治疗选择考虑。
Zotero 插件