Neel Dustin, Davis Eric G, Farmer Russell, Richardson J David
University of Louisville School of Medicine, Louisville, Kentucky, USA.
Am Surg. 2010 Aug;76(8):865-8.
The treatment of emetogenic rupture remained controversial and was particularly so when the patient arrived for definitive care greater than 24 hours postrupture. We treated patients with continued extravasation of contrast from the esophagus by early operation regardless of the timing of their presentation. All primary repairs received a reinforced closure and many delayed repairs had an onlay flap for closure of the leak. We treated 31 patients with emetogenic rupture; 24 of 25 patients with extravasation had operative repair, whereas six with small, contained ruptures were treated medically. Twelve were operated on within 24 hours, whereas 24 presented from 36 to 796 hours postrupture. We were able to achieve closure of the defect by primary suture repair or with a tissue flap in all patients. There were no postoperative leaks. One patient each died in the operated group and observed group. There were minimal complications and a relatively short hospital stay. Our results support the use of aggressive operative treatment for emetogenic rupture regardless of the timing of patient presentation. Such treatment preserved esophageal function and was accomplished with relatively low morbidity and mortality.
致呕性食管破裂的治疗仍存在争议，尤其是当患者在破裂后超过24小时才前来接受确定性治疗时。无论患者就诊时间如何，对于造影剂持续从食管外渗的患者，我们均通过早期手术进行治疗。所有一期修复均进行了加强缝合，许多延迟修复采用了覆盖瓣来封闭漏口。我们共治疗了31例致呕性食管破裂患者；25例有外渗的患者中有24例接受了手术修复，而6例破裂口较小且局限的患者接受了保守治疗。12例在24小时内接受了手术，而24例在破裂后36至796小时就诊。我们能够通过一期缝合修复或组织瓣在所有患者中实现缺损的封闭。术后无漏口发生。手术组和观察组各有1例患者死亡。并发症极少，住院时间相对较短。我们的结果支持对致呕性食管破裂采用积极的手术治疗，无论患者就诊时间如何。这种治疗保留了食管功能，且发病率和死亡率相对较低。
