Institute of Digestive Disease, China Three Gorges University, Yichang, China.
Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China.
J Cardiothorac Surg. 2020 Oct 1;15(1):285. doi: 10.1186/s13019-020-01321-w.
Non-intubated thoracoscopic lung surgery has been reported to be technically feasible and safe. Spontaneous rupture of the esophagus, also known as Boerhaave's syndrome (BS), is rare after chest surgery.
A 60-year-old female non-smoker underwent non-intubated uniportal thoracoscopic wedge resection for a pulmonary nodule. Ultrasound-guided serratus anterior plane block was utilized for postoperative analgesia. However, the patient suffered from severe emesis, chest pain and dyspnea 6 h after the surgery. Emergency chest x-ray revealed right-sided hydropneumothorax. BS was diagnosed by chest tube drainage and computed tomography. Besides antibiotics and tube feeding, a naso-leakage drainage tube was inserted into the right thorax for pleural evacuation. Finally, the esophagus was healed 40d after the conservative treatment.
Perioperative antiemetic therapy is an indispensable item of fast-track surgery. Moreover, BS should be kept in mind when the patients complain of chest distress following emesis after thoracic surgery.
非插管胸腔镜肺手术在技术上是可行且安全的。自发性食管破裂，也称为 Boerhaave 综合征（BS），在胸部手术后很少见。
一位 60 岁的女性非吸烟者因肺部结节接受了非插管单孔胸腔镜楔形切除术。术后采用超声引导的前锯肌平面阻滞进行镇痛。然而，患者在手术后 6 小时出现严重呕吐、胸痛和呼吸困难。急诊胸部 X 光片显示右侧液气胸。通过胸腔引流管和计算机断层扫描诊断为 BS。除了抗生素和管饲外，还向右侧胸腔插入鼻漏引流管以排出胸腔积液。最后，经过 40 天的保守治疗，食管愈合。
围手术期止吐治疗是快速康复外科不可或缺的项目。此外，在胸部手术后出现呕吐和胸痛的患者中，应考虑 BS 的可能性。
