Sakamoto Y, Tanaka N, Furuya T, Ueno T, Okamoto H, Nagai M, Murakawa T, Takayama T, Mafune K, Makuuchi M, Nobori M
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Thorac Cardiovasc Surg. 1997 Dec;45(6):269-72. doi: 10.1055/s-2007-1013747.
Over sixteen years we have gained experience in the delayed surgical management of esophageal rupture in nine patients who received treatments more than 24 hours after perforation. The causes of perforation were Boerhaave's syndrome or barotrauma in four patients, foreign bodies in two, and other causes in three. Three patients presented in septic shock and four in respiratory failure. Three surgical options were used for treatment: simple thoracic drainage in two patients, T-tube placement in four, and esophagectomy with secondary reconstruction in three. Eight patients (89%) survived. T-tube placement was effective in that it was a one-stage operation which could be used on severe esophageal injuries in patients in poor general condition. Three patients who underwent esophagectomy and secondary alimentary restoration required long hospital stays (119,201, and 648 days). Although the number of cases is small, T-tube insertion for the late management of esophageal rupture appears to be a simple and effective method which avoids the postoperative complications associated with primary closure or two-stage operations.
在过去的十六年里，我们积累了对9例食管破裂患者进行延迟手术治疗的经验，这些患者在穿孔后24小时以上才接受治疗。穿孔原因包括4例Boerhaave综合征或气压伤、2例异物损伤以及3例其他原因。3例患者出现感染性休克，4例出现呼吸衰竭。治疗采用了三种手术方式：2例患者行单纯胸腔引流，4例行T管置入，3例行食管切除并二期重建。8例患者（89%）存活。T管置入是一种一期手术，对于全身状况较差的严重食管损伤患者有效。3例行食管切除并二期消化道重建的患者住院时间较长（分别为119天、201天和648天）。尽管病例数量较少，但T管置入用于食管破裂的后期治疗似乎是一种简单有效的方法，可避免与一期缝合或二期手术相关的术后并发症。
