Okamoto Hiroshi, Onodera Ko, Kamba Rikiya, Taniyama Yusuke, Sakurai Tadashi, Heishi Takahiro, Teshima Jin, Hikage Makoto, Sato Chiaki, Maruyama Shota, Onodera Yu, Ishida Hirotaka, Kamei Takashi
Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Department of General Practitioner Development, Graduate School of Medicine, Tohoku University, Sendai, Japan.
J Thorac Dis. 2018 Apr;10(4):2206-2212. doi: 10.21037/jtd.2018.03.136.
The mortality rate of spontaneous esophageal rupture remains 20% to 40% due to severe respiratory failure. We have performed thoracoscopic surgery for esophageal disease at our department since 1994. Sivelestat sodium hydrate reportedly improves the pulmonary outcome in the patients with acute lung injury (ALI).
We retrospectively evaluated the usefulness of thoracoscopic surgery and perioperative administration of sivelestat sodium hydrate for spontaneous esophageal rupture in 12 patients who underwent thoracoscopy at our department between 2002 and 2014.
The patient cohort included 11 males and one female (median age, 61 years). The lower left esophageal wall was perforated in all patients. Surgical procedures consisted of thoracoscopic suture and thoracic drainage in six patients, transhiatal suture and thoracoscopic thoracic drainage in five, and thoracoscopic esophagectomy and thoracic drainage in one. The median time from onset to surgery was 8 hours with a surgical duration of 210 minutes, blood loss 260 mL, postoperative ventilator management 1 day, intensive care unit (ICU) stay 5 days, and interval to restoration of oral ingestion 13 days. Postoperative complications included respiratory failure in four patients, pyothorax in three, and leakage in one. There was no instance of perioperative mortality. Regarding perioperative administration of sivelestat sodium hydrate, the postoperative arterial oxygen partial pressure-to-fractional inspired oxygen ratio (P/F) and C-reactive protein (CRP) levels in the administration group were significantly better than those in the non-administration group on postoperative days 4 (P=0.035) and 5 (P=0.037), respectively. In contrast, there was no significant difference between the groups in median time of ventilator management, ICU stay, oral ingestion following surgery, or hospital stay.
Thoracoscopic surgery obtained acceptable results in all patients, including two with a significant time elapse from onset to treatment. Furthermore, sivelestat sodium hydrate was suggested to help improve postoperative respiration and inflammatory response.
由于严重呼吸衰竭，自发性食管破裂的死亡率仍为20%至40%。自1994年以来，我们科室一直在开展针对食管疾病的胸腔镜手术。据报道，水合西维来司他钠可改善急性肺损伤（ALI）患者的肺部预后。
我们回顾性评估了2002年至2014年间在我们科室接受胸腔镜检查的12例自发性食管破裂患者胸腔镜手术及围手术期给予水合西维来司他钠的有效性。
患者队列包括11名男性和1名女性（中位年龄61岁）。所有患者的食管左下壁均有穿孔。手术方式包括6例胸腔镜缝合及胸腔引流、5例经裂孔缝合及胸腔镜胸腔引流、1例胸腔镜食管切除术及胸腔引流。从发病到手术的中位时间为8小时，手术持续时间210分钟，失血量260毫升，术后呼吸机管理1天，重症监护病房（ICU）住院5天，恢复经口进食的间隔时间为13天。术后并发症包括4例呼吸衰竭、3例脓胸和1例渗漏。围手术期无死亡病例。关于围手术期给予水合西维来司他钠，给药组术后第4天（P=0.035）和第5天（P=0.037）的术后动脉血氧分压与吸入氧分数比（P/F）及C反应蛋白（CRP）水平显著优于未给药组。相比之下，两组在呼吸机管理中位时间、ICU住院时间、术后经口进食时间或住院时间方面无显著差异。
胸腔镜手术在所有患者中均取得了可接受的结果，包括两名从发病到治疗有显著时间延迟的患者。此外，提示水合西维来司他钠有助于改善术后呼吸和炎症反应。
