Pogodina A N, Abakumov M M
Khirurgiia (Mosk). 1998(10):20-4.
Results of combined treatment of 850 patients with penetrating mechanical injuries of the esophagus are presented. 368 patients had instrumental lesions, 328--foreign bodies, 53--spontaneous and hydraulic ruptures, 83--gun-shot and cut wounds. Complex of roentgenologic, endoscopic, ultrasound and immunologic methods of examination were used for diagnosis of penetrating injuries of the esophagus and their complications. The authors have developed indications for conservative and operative methods of treatment. 650 patients underwent surgery. In 388 patients drainage procedures were used, other procedures used were suturing of defect of esophageal wall (288p), exclusion of distal part of the esophagus (30p). Mortality rate in such operations made up, respectively, 33, 11.8 and 6.6%. Methods of active drainage were successfully used in treatment of complication in ruptures of the esophagus (mediastinitis, empyema of the pleura). The most severe complications of the ruptures of the esophagus and mediastinitis were arrosion bleedings and esophageal fistulas. Methods of treatment of these complications are described.
本文介绍了850例食管穿透性机械损伤患者的综合治疗结果。其中368例为器械损伤，328例为异物损伤，53例为自发性和水压性破裂，83例为枪伤和切割伤。采用X线、内镜、超声和免疫等综合检查方法诊断食管穿透伤及其并发症。作者制定了保守治疗和手术治疗的适应证。650例患者接受了手术。388例患者采用了引流手术，其他手术包括食管壁缺损缝合（288例）、食管远端切除（30例）。此类手术的死亡率分别为33%、11.8%和6.6%。主动引流方法成功用于治疗食管破裂的并发症（纵隔炎、胸膜腔积脓）。食管破裂和纵隔炎最严重的并发症是糜烂出血和食管瘘。文中描述了这些并发症的治疗方法。
