The Clinical Observation Of Primary Repair Performed In Delayed Spontaneous Rupture Of Esophagus

Background:Spontaneous esophageal rupture is extremely rare, and early symptoms of the disease are similar to those of emergency diseases of the chest and abdomen. The diagnosis and treatment are often delayed, resulting in an unfavorable outcome in some cases.Objective:To summarize experience of primary repair used in delayed spontaneous rupture of esophagus, in order to improve the levels diagnosis and surgical treatment of the disease.Methods:A restrospective review was performed on clinical curative effect records of22patents with delayed spontaneous rupture of esophagus in our department from January2000to December2013, which the delayed was more than24hours. The patients were divided into two groups:13patients in operation group received primary repair operation, while other9patients in operation group received primary repair operation. The operation group involves13patients, all male. Average age is36-70(52.4±12.8) years old, whose time lapses were28-214(72.3±24.5) hours from onset to diagnose. The rupture site of10cases is in middle lower segment of esophagus, another3cases is in lower esophagus. The length of the rupture ranged from6to15cm, and one case has two rupture sites. In2cases, ruptures broke into the left thoracic cavity, right in7cases and both into4cases. Control group is the group which those patients refused operation management instead of conservative treatment even if they still have a chance of operation. The control group involves9patients,7male and2female. Average age is47-67(56.1±9.7) years old, whose time lapses were26-120(67.3±19.8) hours from onset to diagnose. The rupture site of cases is all in middle lower segment of esophagus. The length of the rupture ranged from3to7cm, and one case has two rupture sites. In2cases, ruptures broke into the left thoracic cavity, right in5cases and both into2cases. Diagnostic methods include oral methylene blue dye after thoracentesis, upper gastrointestinal lipiodol angiography, esophagoscopy. chest X-ray and chest CT. The treatment in control group includes fasting, gastrointestinal decompression, thoracic drainage, nutritional support, and so on. All patients in operation group received surgical procedure as follows:empyema clearance, fibreboard exfoliation and primary suture. After operation, all patients received treatments including gastrointestinal decompression, thoracic drainage, nutritional support, and so on.Rusults:All patients in operation group were cured.6patents were primary cured (46.14%).7patients experienced postoperative leakage (53.86%) and cured after conservative therapy. One patient showed respiratory failure and cured after ventilator-assisted breathing within two weeks. One patient showed infection of incisional wound and1patients showed pulmonary infection (7.7%). The time of rupture heal ranged from13.5to61.3(33.6±18.4) days, the time of Hospitalization ranged from16.2to73.6(40.3±22.1) days. In control group,8patients were cured while one patient died of systemic failure due to malnutrition(11.1%).4patients showed empyema and4patients showed pulmonary infection (44.4%). The time of rupture heal ranged from48.8to74.8(62.1±7.6) days, the time of Hospitalization ranged from58.6to90.9(76.3±10.2) days.Conclusion:It is effective that primary repair for delayed spontaneous rupture of esophagus. Compared with the conservative treatment, primary repair can shorten the time of healing and hospitalization,and reduce the incidence of complications. The key of primary repair to success is:repeated washing, thorough debridement, appropriate suture and adequate drainage.