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目的:探讨外科治疗延迟诊断的晚期自发性食管破裂合并脓胸的价值。方法:回顾性分析2007年9月至2010年5月南方医科大学珠江医院收治的3例晚期自发性食管破裂患者的临床资料,明确诊断后行剖胸探查及脓胸廓清术,1例患者予带蒂肋间肌瓣修复,2例未做修补,术中同期行空肠造瘘。术后予呼吸机辅助呼吸、持续胸腔冲洗及引流、肠内外营养支持等处理。结果:3例患者手术过程顺利,无手术死亡;手术时间180～270 min,平均手术时间210 min;术后无脓胸、肺部感染等明显并发症;住院时间35～76 d,平均住院时间37 d。平均随访时间1.5年,患者无食管狭窄、反流性食管炎发生,日常工作和生活正常。结论:对延误诊断的晚期自发性食管破裂,手术的指征应尽量放宽,只要患者全身情况许可,应强调尽早外科手术治疗。
Objective: To investigate the value of delayed diagnosis of advanced surgical esophageal rupture with empyema. Methods: The clinical data of 3 patients with advanced spontaneous rupture of esophagus ruptured admitted to Zhujiang Hospital of Southern Medical University from September 2007 to May 2010 were retrospectively analyzed. Thoracotomy and empyema were performed after diagnosis. One patient Pedicled intercostal muscle flap repair, 2 cases did not make repairs, surgery during the same period jejunal fistula. Postoperative ventilator assisted breathing, sustained chest irrigation and drainage, enteral nutrition support and other treatment. Results: The operation procedure was successful and no operation was lost in 3 patients. The operation time was 180-270 min with an average operation time of 210 min. There were no significant complications such as empyema and pulmonary infection after operation. The average length of hospital stay was 35-76 days, 37 d. The average follow-up time of 1.5 years, patients without esophageal stricture, reflux esophagitis occurred, daily work and normal life. Conclusion: Delayed diagnosis of advanced spontaneous esophageal rupture, surgical indications should be relaxed as long as the general situation of patients with permission, should emphasize as soon as possible surgical treatment.