Nakano Toru, Onodera Ko, Ichikawa Hirofumi, Kamei Takashi, Taniyama Yusuke, Sakurai Tadashi, Miyata Go
Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
Division of Gastroenterologic and Hepatobiliarypancreatic Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi 983-8560, Japan.
J Thorac Dis. 2018 Feb;10(2):784-789. doi: 10.21037/jtd.2018.01.50.
Spontaneous esophageal rupture (Boerhaave's syndrome) is an emergency that can cause life-threatening conditions. Various procedures have been used to treat Boerhaave's syndrome. However, a standard surgical procedure has not been established. Herein, we report our experience with primary suture of the ruptured esophagus via a thoracoscopy or laparotomy.
Between November 2002 and May 2015, 11 patients with Boerhaave's syndrome presented to our department and were managed using one of two surgical procedures based on the surgeon's discretion. Six patients underwent a thoracoscopic primary suture and drainage (group A); 5 patients underwent a primary suture via laparotomy followed by thoracoscopic drainage (group B). Patient medical records were retrospectively reviewed.
The mean interval between initial perforation and surgery was 13.7 h (group A) and 17.2 h (group B) (P=0.7307). The mean operative time was 190 min (group A) and 249 min (group B) (P=0.106). Patient baseline characteristics and surgical outcomes were similar for both surgical procedures. One patient in each group experienced postoperative leakage that did not require surgical intervention.
The results suggest that thoracoscopic esophageal repair, as well as suturing via laparotomy, is a good surgical alternative for patients with Boerhaave's syndrome.
自发性食管破裂（Boerhaave综合征）是一种可导致危及生命状况的急症。已采用各种手术方法治疗Boerhaave综合征。然而，尚未确立标准的手术方法。在此，我们报告经胸腔镜或剖腹手术对破裂食管进行一期缝合的经验。
2002年11月至2015年5月，11例Boerhaave综合征患者就诊于我科，根据外科医生的判断采用两种手术方法之一进行治疗。6例患者接受胸腔镜一期缝合及引流（A组）；5例患者经剖腹手术进行一期缝合，随后行胸腔镜引流（B组）。对患者病历进行回顾性分析。
初次穿孔至手术之间的平均间隔时间，A组为13.7小时，B组为17.2小时（P = 0.7307）。平均手术时间，A组为190分钟，B组为249分钟（P = 0.106）。两种手术方法的患者基线特征和手术结果相似。每组各有1例患者出现术后渗漏，但无需手术干预。
结果表明，胸腔镜食管修复以及经剖腹手术缝合，对于Boerhaave综合征患者是良好的手术选择。
