Minami H, Kubota F, Kajiwara K, Itoyanagi N, Shingu H
Department of Surgery, Sasebo General Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Jan;38(1):111-5.
A case of pneumatic esophageal rupture secondary to distension from compressed air was reported. The patient, a 69-year-old man who was repairing an automobile tire suddenly exploded. The blast was directed into the open mouth. He was admitted to our hospital 12 hours after the onset with the complaint of chest pain and dyspnea. Subcutaneous emphysema was seen in the neck. The chest roentgenogram revealed a partial right hydropneumothorax. The diagnosis of esophageal rupture was established by Gastrographin swallowing study. Operation was performed 46 hours after the onset. Primary closure of the middle thoracic esophagus was judged to be impossible because of a 6 cm longitudinal laceration with contaminated pyothorax. Thereafter, total esophagectomy was indicated. Esophageal reconstruction using the pediculated gastric tube was performed throughout the retrosternal route. The leakage of esophagogastrostomy in the cervical area occurred in early postoperative stage. Re-esophagogastrostomy was successfully carried out 6 weeks after the first surgery. He is uneventful 6 months after the operation. We have not found any reports of surgical cases with pneumatic esophageal rupture treated by this approach in the literature.
报道了一例因压缩空气膨胀导致的气压性食管破裂病例。患者为一名69岁男性，当时正在修理汽车轮胎，轮胎突然爆炸，气流冲向其张开的口腔。发病12小时后，他因胸痛和呼吸困难被收治入我院。颈部可见皮下气肿。胸部X线片显示右侧部分液气胸。通过泛影葡胺吞咽造影检查确诊为食管破裂。发病46小时后进行了手术。由于存在6厘米的纵行撕裂伤并伴有脓胸污染，判断无法对胸段中段食管进行一期缝合。此后，决定行全食管切除术。采用带蒂胃管经胸骨后途径进行食管重建。术后早期出现了颈部食管胃吻合口漏。首次手术后6周成功进行了再次食管胃吻合术。术后6个月他情况良好。我们在文献中未发现采用这种方法治疗气压性食管破裂手术病例的相关报道。
