Loske Gunnar, Albers Katrin, Mueller Christian T
Department for General, Abdominal, Thoracic and Vascular Surgery, Katholisches Marienkrankenhaus Hamburg gGmbH, Hamburg, Germany.
Clinic for Anaesthesiology, Pain Therapy and Intensive Care, Katholisches Marienkrankenhaus Hamburg gGmbH, Hamburg, Germany.
Innov Surg Sci. 2021 Apr 6;6(2):81-86. doi: 10.1515/iss-2020-0043. eCollection 2021 Jun.
Boerhaave's syndrome is a life-threatening disease with high mortality and morbidity. Endoscopic negative pressure therapy (ENPT) can be used to treat oesophageal perforations.
We report on a case of oesophageal rupture with peritonitis in a 35-year-old male patient. The start of treatment was 11 h after the perforation event. The treatment of the perforation defect was performed exclusively by intraluminal ENPT, the treatment of peritonitis was performed by laparotomy with abdominal lavage. For ENPT we used two different types of open-pore drains. The first treatment cycle of four days was performed with an open-pored polyurethane foam drainage (OPD), which was placed intraluminal to cover the perforation defect and to empty the stomach permanently. The second treatment cycle of nine days was performed with a thin nasogastric tube like double-lumen open-pored film drainage (OFD). For suction OPD and OFD were connected with an electronic vacuum pump (-125 mmHg). OFD enables active gastric emptying with simultaneous intestinal feeding via an integrated feeding tube. Intraluminal ENPT with a total treatment duration of 13 days was able to achieve the complete healing of the defect. Surgical treatment of the perforation defect was not necessary. The patient was discharged 20 days after initial treatment with a non-irritating abdominal wound and a closed perforation.
In suitable cases, endoscopic negative pressure therapy is a minimally invasive, organ-preserving procedure for the treatment of spontaneous oesophageal rupture.
博雷尔哈夫综合征是一种危及生命的疾病，死亡率和发病率都很高。内镜负压治疗（ENPT）可用于治疗食管穿孔。
我们报告了一例35岁男性患者食管破裂伴腹膜炎的病例。穿孔事件发生11小时后开始治疗。穿孔缺损仅通过腔内ENPT进行治疗，腹膜炎通过剖腹手术和腹腔灌洗进行治疗。对于ENPT，我们使用了两种不同类型的开孔引流管。第一个为期四天的治疗周期使用开孔聚氨酯泡沫引流管（OPD），将其放置在腔内以覆盖穿孔缺损并永久排空胃。第二个为期九天的治疗周期使用细鼻胃管样双腔开孔薄膜引流管（OFD）。为了进行吸引，OPD和OFD与电子真空泵（-125 mmHg）相连。OFD能够通过集成的 feeding tube实现主动胃排空并同时进行肠内喂养。总治疗时长为13天的腔内ENPT能够使缺损完全愈合。无需对穿孔缺损进行手术治疗。患者在初始治疗20天后出院，腹部伤口无刺激且穿孔已闭合。
在合适的病例中，内镜负压治疗是一种用于治疗自发性食管破裂的微创、保留器官的手术方法。
