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find Keyword "食管穿孔" 3 results
  • 继发性纵隔脓肿的诊断与治疗

    目的 探讨多种原因导致的继发性纵隔脓肿的诊断和综合治疗方法。 方法 回顾性分析1988年12月至2007年11月中国医科大学附属第一医院收治的23例继发性纵隔脓肿的临床资料,男18例,女5例;年龄13个月~76岁,平均年龄40.9岁。致病原因:食管穿孔或破裂14例(外伤致食管破裂7例、医源性食管破裂6例、自发性食管破裂1例),咽部脓肿5例,口底蜂窝组织炎2例,气管断裂2例。采取以外科手术治疗为主,辅以抗感染和营养支持治疗。行食管破裂修补术10例次,空肠或胃造瘘术6例次,脓胸纤维板剥脱术4例次,经颈部切口上纵隔引流术15例次,胸腔闭式引流术7例次,肺叶部分切除术2例次,心包引流术1例次,牙周和颌下切开引流术1例次。 结果 住院死亡5例,病死率21.7%(5/23),死于中毒性休克4例,静脉大出血1例。出院时完全治愈或病情稳定18例。随访16例,随访时间6~18个月,随访期间生存患者生活质量提高,死于脑血管意外1例;失访2例。 结论 继发性纵隔脓肿病情发展迅速,且病死率高,应早期诊断,充分的外科引流、合理使用抗生素和营养支持是治疗的关键。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • 外科途径治疗经保守处理无效的食管异物

    目的 探讨保守治疗无效的食管异物经外科治疗的手术途径和方法,以减少手术对患者的损伤和术后并发症的发生、促进患者快速康复。 方法 回顾性分析 2011 年 6 月至 2016 年 8 月我院食管异物经保守治疗无效需外科手术治疗 37 例患者的临床资料,其中男 21 例、女 16 例,年龄 17~62(42.00±9.75)岁。8 例经颈部切口手术治疗,27 例经胸部切口取出异物,2 例经胸腔镜取出异物。 结果 随访 3~18(7.95±3.41)个月,4 例术后发生消化瘘患者在术后 2~5 个月能正常进食,其余患者均在术后 1 个月能正常进软质饮食,术后 1.5 个月正常饮食。2 例手术患者因术后纵隔感染、胸腔感染致脓毒血症,多器官功能衰竭死亡。 结论 食管异物的外科手术根据其嵌顿的位置不同、穿孔与否、手术路径及方法亦有所不同,采取适宜的手术途径和方法可以提高手术的准确性,减少手术对食管的损伤和术后并发症,减轻患者的痛苦,从而提高患者术后生存质量。

    Release date:2018-06-01 07:11 Export PDF Favorites Scan
  • Prognostic evaluation of benign esophageal perforation with perforation severity score and Charlson comorbidity index score

    ObjectiveTo evaluate the prognosis of benign esophageal perforation by Pittsburgh scoring system (perforation severity scores, PSS) combined with co-disease index (Charlson comorbidity index, CCI).MethodsThirty patients with benign esophageal perforation from August 2016 to August 2018 in our hospital diagnosed by imaging or endoscopy were selected, including 14 males and 16 females, aged 68.660±10.072 years. After treatment, we retrospectively analyzed whether there was any complication in the course of treatment, the healing of esophageal perforation at discharge and the follow-up after discharge. And the patients were divided into a stable group (20 patients with no complication, clear healing of esophageal perforation at discharge or death during follow-up) and an unstable condition group (10 patients with complications, esophageal perforation at discharge or death during follow-up). Complete clinical data of all the patients were obtained and were able to be calculated by the scores of PSS and CCI scoring system. The difference of PSS and CCI scores between the two groups was compared, and the clinical value of PSS combined with CCI score in the prognosis of benign esophageal perforation was analyzed.ResultsIn the stable group, the PSS was 2.750±1.372 (95%CI 2.110 to 3.390), CCI score was 2.080±1.055 (95%CI 1.650 to 2.500) with a statistical difference between the two systems (P=0.000). In the unstable group, PSS was 7.300 ±1.829 (95%CI 7.300 to 8.120), CCI was 4.640±1.287 (95%CI 4.220 to 5.060) with a statistical difference between the two systems (P<0.05). The area under the receiver operating characteristic curve of PSS and CCI scores in the prognostic evaluation of benign esophageal perforation was 0.982 and 0.870 respectively, which was statistically significant (P<0.05).ConclusionEsophageal perforation is a dangerous condition. It is of great practical value to evaluate the condition of esophageal perforation by PSS and CCI scores.

    Release date:2019-06-18 10:20 Export PDF Favorites Scan
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