Huang Zhao, Zhao Penglong, Qiu Bingmei, Gao Chuan, Chen Zhao, Yang Nan, Xu Yang, Zou Zhiqiang, Shen Yi, Hu Liwen
Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
Department of Cardiothoracic Surgery, The 960th Hospital of PLA, Jinan, Shandong Province, China.
World J Emerg Surg. 2025 Jun 7;20(1):51. doi: 10.1186/s13017-025-00630-6.
Spontaneous esophageal rupture (SER) is a rare and severe emergency with high mortality, and the treatment algorithm remains controversial.
This retrospective study analyzed SER cases that underwent VATS debridement and drainage in Jinling Hospital from January 2014 to July 2024. Patients were divided into Lavage-Drainage and Drainage groups based on whether they received a lavage tube cathetering through the esophageal fistula under gastroscope. Preoperative fluid resuscitation, thoracoscopic mediastinotomy, and thoracic debridement were performed. Post-operative management included fasting, enteral nutrition, anti-infective agents, and fluid and electrolyte balance maintenance. Monitoring indicators included vital signs, laboratory test results, postoperative complications, and other relevant factors.
A total of 24 patients were enrolled, with 11 in the Lavage-Drainage group and 13 in the Drainage group. The Lavage-Drainage group had lower 30-day mortality, fewer complications and adverse events, and a faster reduction in inflammatory factors, but a higher cost. There was no significant difference in the length of mechanical ventilation, hospital stay, and ICU stay.
The Lavage-Drainage approach enhanced the drainage efficiency, reduced the inflammation level, and improved the prognosis of SER. However, this study has some limitations, and further multi-center prospective studies are needed to optimize the treatment and reduce costs.
自发性食管破裂（SER）是一种罕见且严重的急症，死亡率高，治疗方案仍存在争议。
本回顾性研究分析了2014年1月至2024年7月在金陵医院接受电视辅助胸腔镜清创引流术的SER病例。根据患者在胃镜下是否通过食管瘘置入灌洗管，将患者分为灌洗引流组和单纯引流组。术前进行液体复苏、胸腔镜纵隔切开术和胸腔清创术。术后管理包括禁食、肠内营养、抗感染药物以及维持液体和电解质平衡。监测指标包括生命体征、实验室检查结果、术后并发症及其他相关因素。
共纳入24例患者，灌洗引流组11例，单纯引流组13例。灌洗引流组30天死亡率较低，并发症和不良事件较少，炎症因子下降更快，但费用较高。机械通气时间、住院时间和重症监护病房住院时间无显著差异。
灌洗引流方法提高了引流效率，降低了炎症水平，改善了SER的预后。然而，本研究存在一定局限性，需要进一步开展多中心前瞻性研究以优化治疗方案并降低费用。
