三级食管胃中心布尔哈夫综合征的外科治疗
Surgical management of Boerhaave's syndrome in a tertiary oesophagogastric centre.
作者信息
Sutcliffe Robert P, Forshaw Matthew J, Datta Gourab, Rohatgi Ashish, Strauss Dirk C, Mason Robert C, Botha Abraham J
机构信息
Department of Surgery, St Thomas' Hospital, London, UK.
出版信息
Ann R Coll Surg Engl. 2009 Jul;91(5):374-80. doi: 10.1308/003588409X428298. Epub 2009 Apr 30.
INTRODUCTION
The aim of this study was to review the management and outcome of patients with Boerhaave's syndrome in a specialist centre between 2000-2007.
PATIENTS AND METHODS
Patients were grouped according to time from symptoms to referral (early, < 24 h; late, > 24 h). The effects of referral time and management on outcomes (oesophageal leak, reoperation and mortality) were evaluated.
RESULTS
Of 21 patients (early 10; late 11), three were unfit for surgery. Of the remaining 18, immediate surgery was performed in 8/8 referred early and 6/10 referred late. Four patients referred late were treated conservatively. Oesophageal leak (78% versus 12.5%; P < 0.05) and mortality (40% versus 0%; P < 0.05) rates were higher in patients referred late. For patients referred late, mortality was higher in patients managed conservatively (75% versus 17%; not significant).
CONCLUSIONS
The best outcomes in Boerhaave's syndrome are associated with early referral and surgical management in a specialist centre. Surgery appears to be superior to conservative treatment for patients referred late.
引言
本研究旨在回顾2000年至2007年间在一家专科中心对患有博赫哈夫综合征患者的治疗及预后情况。
患者与方法
根据从出现症状到转诊的时间（早期，<24小时；晚期，>24小时）对患者进行分组。评估转诊时间和治疗方法对预后（食管瘘、再次手术和死亡率）的影响。
结果
21例患者（早期10例；晚期11例）中，3例不适合手术。其余18例中，8例早期转诊患者均立即接受了手术，10例晚期转诊患者中有6例立即接受了手术。4例晚期转诊患者接受了保守治疗。晚期转诊患者的食管瘘发生率（78%对12.5%；P<0.05）和死亡率（40%对0%；P<0.05）更高。对于晚期转诊患者，保守治疗患者的死亡率更高（75%对17%；无显著性差异）。
结论
博赫哈夫综合征的最佳预后与早期转诊至专科中心并接受手术治疗相关。对于晚期转诊患者，手术治疗似乎优于保守治疗。
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