Brauer R B, Liebermann-Meffert D, Stein H J, Bartels H, Siewert J R
Department of Surgery, Technische Universität München, Germany.
Dis Esophagus. 1997 Jan;10(1):64-8. doi: 10.1093/dote/10.1.64.
Postemetic spontaneous rupture of the esophagus is an intrathoracic disaster which is generally lethal if untreated. The tragedy seems to strike more often than commonly suspected. The current literature review focuses on publications since 1980 and includes the retrospective review of 18 additional patients treated in our hospital for spontaneous rupture of the esophagus. Frequently, a wide variety of unspecific symptoms has led to the mistaken diagnosis of an acute abdomen, pancreatitis or cardiac arrest. About 40% of the patients with spontaneous rupture of the esophagus presented a history of alcoholism or heavy drinking and 41% suffered from gastroduodenal ulcer disease. Pain (83%) and vomiting (79%) often associated with dyspnea (39%) and shock (32%) are the major symptoms. This unspecific symptomatology delayed the correct diagnosis of the Boerhaave's syndrome and resulted in a significant complication rate. The mortality rate associated with Boerhaave's syndrome was 50% from the first successful surgical repair in 1947 by Barrett to 1980. After 1980, however, the mortality rate dropped to 31%, because of earlier diagnosis, surgical repair and improvement in intensive care. When surgery is delayed, the prognosis of patients with spontaneous rupture of the esophagus is in general severe.
呕吐后食管自发性破裂是一种胸腔内的灾难性疾病，如果不治疗通常会致命。这种悲剧的发生频率似乎比人们普遍认为的要高。当前的文献综述聚焦于1980年以来的出版物，并包括对我院另外18例食管自发性破裂患者的回顾性研究。通常，各种各样的非特异性症状导致了对急腹症、胰腺炎或心脏骤停的误诊。约40%的食管自发性破裂患者有酗酒或大量饮酒史，41%患有胃十二指肠溃疡病。疼痛（83%）、呕吐（79%），常伴有呼吸困难（39%）和休克（32%）是主要症状。这种非特异性症状学延误了对博雷尔哈夫综合征的正确诊断，并导致了较高的并发症发生率。从1947年巴雷特首次成功进行手术修复到1980年，与博雷尔哈夫综合征相关的死亡率为50%。然而，1980年以后，由于早期诊断、手术修复和重症监护的改善，死亡率降至31%。如果手术延迟，食管自发性破裂患者的总体预后通常很严重。
