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胸部外伤性食管破裂少见,易误诊。现将我院经X线诊断证实2例报告如下。 例1.患者男,20岁。5天前酒后骑摩托车与汽车相撞,当即昏迷,送当地医院诊治。当日患者饮水后即呕吐,为胃内容物。次日出现胸闷,呼吸困难,烦躁不安。胸透见两侧胸膜腔大量液气胸,钡餐检查见食管破裂。遂予以胸腔闭式引流转入我院。外科情况:胸廓饱满,双肺叩实,呼吸音减低,经两侧胸膜腔引流出大量带恶臭味脓液。X线检查:鉴于患者一般情况较差,予以半卧位透视,见两侧液气胸,右肺组织被压缩约10％。左侧液气胸伴多发性包裹性液气胸,肺组织压缩约40％。随即仰卧位服70％泛影葡胺100ml,见造影剂迅速经食管下段破裂处进入双侧胸膜腔,确诊为食管下段破裂,虽经积极抗感染、深静脉高营养,输血、空肠造瘘及各种支持疗法等,但因患者不配合治疗,多次趁人不备,自拔引流管及多次饮水,终因中毒性休克、呼吸循环衰竭死亡。
Chest traumatic esophageal rupture rare, easily misdiagnosed. Now our hospital confirmed by X-ray diagnosis of 2 cases are as follows. Example 1. Patient male, 20 years old. 5 days ago drunk riding a motorcycle collided with the car, immediately coma, sent to the local hospital for treatment. The patient vomit on the day after drinking water, stomach contents. Chest tightness appeared the next day, breathing difficulties, irritability. Chest see a large number of pleural cavity on both sides of the liquid pneumothorax, barium meal examination found esophageal rupture. Then be closed thoracic drainage into our hospital. Surgical conditions: full thorax, lung tapping reality, reduced respiratory sounds, drainage through the pleural cavity on both sides with a large number of stinky pus. X-ray examination: given the poor general condition of the patient, to be semi-supine perspective, see both sides of the liquid pneumothorax, right lung tissue is compressed by about 10%. Left liquid pneumothorax with multiple paroxysmal liquid pneumothorax, lung tissue compression about 40%. Immediately supine 70% diatrizoate meglumine 100ml, see the contrast agent rapidly through the lower esophageal rupture into the bilateral pleural cavity, diagnosed with lower esophageal rupture, although the active anti-infective, deep vein nutrition, blood transfusion, jejunostomy and A variety of supportive therapies, but because of the patient does not cooperate with the treatment, repeatedly taking advantage of others, extubation and multiple drinking water, and finally due to toxic shock, respiratory failure death.