CAJ | 학술논문

目的探讨骨性异物所致胸段食管破裂穿孔的分类及其治疗方法.方法对57例胸段食管骨性异物破裂穿孔患者根据食管损伤性质和继发感染程度进行分类,分别采取不同手术方式并总结其疗效.结果 Ⅰ类为食管破裂、纵隔无脓肿形成,共计17例;其中直接食管破口连续缝合修补7例,直接缝合修补后,外穿孔部位用肋间肌加强6例,心包和带蒂大网膜加强各2例.Ⅱ类为纵膈脓肿期,共计13例;其中食管穿孔切除、胃代食管10例,纵隔脓肿清除胸腔引流3例.Ⅲ类为脓胸期,即骨性异物穿破食管后感染波及胸腔而形成脓胸,共计21例;其中食管穿孔切除、一期胃带食管12例,食管穿孔切除、二期胃或结肠带食管9例.Ⅳ类为脓肿侵犯周围器官并形成主动脉-食管瘘或气管食管瘘,共计6例;气管瘘修补、大网膜填塞、二期胃或结肠代食管术4例,病变段血管切除、人工血管置换、二期胃或结肠代食管2例.Ⅰ、Ⅱ、Ⅲ类的51例患者50例获治愈,1例死于脓毒症引起的多脏器功能衰竭综合征.Ⅳ类的6例患者术前准备时麻醉诱导过程死亡1例,手术死亡1例,死因皆为食管-主动脉瘘导致的大出血,其余4例治愈.结论对骨性异物所致胸段食管损伤病变进行分类,并采取相应方法治疗有助于提高疗效;一旦确诊均应采取积极的手术方式.
목적 탐토골성이물소치흉단식관파렬천공적분류급기치료방법.방법 대57례흉단식관골성이물파렬천공환자근거식관손상성질화계발감염정도진행분류,분별채취불동수술방식병총결기료효.결과 Ⅰ류위식관파렬、종격무농종형성,공계17례;기중직접식관파구련속봉합수보7례,직접봉합수보후,외천공부위용륵간기가강6례,심포화대체대망막가강각2례.Ⅱ류위종격농종기,공계13례;기중식관천공절제、위대식관10례,종격농종청제흉강인류3례.Ⅲ류위농흉기,즉골성이물천파식관후감염파급흉강이형성농흉,공계21례;기중식관천공절제、일기위대식관12례,식관천공절제、이기위혹결장대식관9례.Ⅳ류위농종침범주위기관병형성주동맥-식관루혹기관식관루,공계6례;기관루수보、대망막전새、이기위혹결장대식관술4례,병변단혈관절제、인공혈관치환、이기위혹결장대식관2례.Ⅰ、Ⅱ、Ⅲ류적51례환자50례획치유,1례사우농독증인기적다장기공능쇠갈종합정.Ⅳ류적6례환자술전준비시마취유도과정사망1례,수술사망1례,사인개위식관-주동맥루도치적대출혈,기여4례치유.결론 대골성이물소치흉단식관손상병변진행분류,병채취상응방법치료유조우제고료효;일단학진균응채취적겁적수술방식.
Objective To evaluate the staging critera and surgical treatment strategy of traumalic intrathoracic esophageal peffomtions by foreign bone. Methods Fifty-seven patients with intrathoracic esophageal perforations caused by foreign bone in our department from January 1980 to June 2006 were studied.Patients were divided into 4 grades:gmde Ⅰ was esophageal perforation without mediastinitis (n=17),grade Ⅱ was esophageal pedomtion with severe mediastinitis (n=13),grade Ⅲ was esophageal perforation with severe empyema(n=21),graae Ⅳ was esophageal perforation with tracheal or aorto-esophageal fistula(n=6).Based on the stage of esophageal perforation,operative procedures were selected including esophagotomy,esophageal repair,esophagectomy,mediastinal drainage,and esophagus reconstruction with colon. Results In grade Ⅰ,Ⅱ and Ⅲ,all but one pailent experienced satisfactory healing of the esophagus.One patient died of multi-organ failure from septic complication.No leakage was observed.Normal swallowing function and improved weight gain was achieved in all the patients.There were 2 deaths in grade Ⅳ(2/6). Conclusions Grading of esophageal perforation caused by foreign bone is helpful to the decision of surgical treatment strategy.