Паёми Сино (Jun 2020)
SURGICAL TACTICS IN PATIENTS WITH SPONTANEOUS ESOPHAGUS RUPTURE
Abstract
Objective: Improving treatment outcomes for patients with spontaneous esophageal rupture by determining optimal surgical tactics. Methods: The results of the treatment of 25 patients with spontaneous esophageal rupture were studied. The average age of patients was 47±7 years. In the first 6 hours to the hospital admission the diagnosis of spontaneous esophageal rupture was established in 6 patients, Boerhaave syndrome was diagnosed in 7 patients in the period from 6 to 12 hours, in 6 patients – from 12 to 24 hours, in 6 – from 24 to 36 hours. All patients were operated. Results: Complicated course of the postoperative period observed in all cases. The main complications were pneumonia (60%), mediastinitis (50%), pleural empyema (60%), and sepsis (30%). The most complicated number of cases is that patients who were underwent laparotomy, right thoracotomy or laparotomy and thoracotomy. Lack of esophageal sutures developed in 10 (40%) patients on 5-6 days of the postoperative period. Of these 6 cases were used conservative methods: esophageal stent placement (2), endovac therapy (2), drainage of the pleural cavity, and exclusion of the esophagus from digestion (2). Four patients were re-operated: suturing of the esophageal defect, and drainage of the pleural cavity. The duration of hospitalization was 35±8 days, and mortality rate – 28%. Conclusion: The results of treatment depend on the type of operative access through which implementing the esophagus suture and the sanitation of the pleural cavity. The optimal operative approach is left-sided thoracotomy. Despite the achievements of modern medicine and emergency surgery, the treatment of patients with spontaneous esophageal ruptures remains an insufficiently studied problem. Having considered the small number of patients and clinical observations for further it is necessary to investigate in this direction for the purpose of validating the results.
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