Experiența secției chirurgie toracică SCR în traumatismele esofagiene

Abstract

Introducere: Trauma esofagiană este o patologie gravă şi sursa anumitor complicații, uneori incompatibile cu viața pacientului. Analizăm experiența secției noastre în managementul traumatismelor grave esofagiene. Material şi metode: În secția chirurgie toracică a SCR, în anii 1970-2010, au fost tratate 311 cazuri de patologie acută esofagiană, dintre care 227 cu combustii (142 bărbați şi 85 femei), 52 cu ingestie de corp străin (32 bărbați şi 20 femei), 17 cu sindromul Boerhaave (12 bărbați şi 5 femei), 15 cu iatrogenii. A fost analizată relația între mortalitate şi componentele managementului chirurgical (timpul de la momentul perforației pînă la operație, localizarea plăgii esofagiene, etc.). Rezultate: Perforația esofagiană a fost întîlnită în 37 (12%) de cazuri: 7 (18,90%) – în combustie chimică a esofagului; 15 (40,54%) – în leziune prin ingestie de corpi străini; 15 (40,54%) –iatrogenii. Letalitatea generală în grupul total de pacienți (311) a fost 12,54%, inclusiv în lotul cu combustii – 27 decese (11,89%); în leziunile prin ingestie de corp străin – 5 decese (10%); în sindromul Boerhaave – 7 decese (41,17%). Concluzii: 1. Etiologia perforațiilor esofagiene este variată, predominînd ingestia de corpi străini şi iatrogeniile. 2. Se remarcă letalitatea excesivă în grupul pacienților cu sindrom Boerhaave, ce corelează cu deficiențele diagnostice şi terapeutice în aceste cazuri. 3. Prezența corelației directe între timpul scurs de la accident, cauza determinantă, circumstanțele în care a avut loc traumatismul, tipul şi nivelul la care se situează leziunea, şi respectiv acordarea ajutorului medical de urgență sunt factori care dictează prognosticul.

Introduction: Esophageal trauma is a severe pathology, and as being a source of certain complications sometimes is incompatible with human life. We analyze the experience of our department in management of severe esophageal traumas. Materials and methods: Between 1970-2010, in thoracic surgery department there have been treated 311 cases of acute esophageral pathology: 227 cases with combustions (142 men and 85 women), 52 with foreign body ingestions (32 men and 20 women), 17 with Boerhaave syndrome (12 men and 5 women), 15 with iatrogenies. There was established the correlation between the mortality and surgical management components ( perforation-surgery period, location of esophageal injury etc.). Results: Esophageal perforation has been determined in 37 (12%) cases: 7 (18,90%) – chemical combustion of the esophagus; 15 (40,54%) – injury through ingestion of foreign bodies; 15 (40,54%) – iatrogenies. General letality from the total group of patients (311) was 12,54%: 27 deceases (11,89%) – from the combustion group; 5 deceases (10%) – from the foreign body injury group; 7 deceases (41,17%) – from the Boerhaave syndrome group. Conclusions: 1. The etiology of esophageal perforations is varied, and predominates the injury through foreign body ingestion and iatrogenies. 2. An excessive letality is remarked in the group of patients with Boerhaave syndrome, the fact that correlates with diagnostic and therapeutic deficiency in this cases. 3. The direct correlation between the time of the accident, determinating cause, trauma circumstances, location and type of the injury and instant medical assistance are factors that dictate the prognostic.

Introduction: Esophageal trauma is a severe pathology, and as being a source of certain complications sometimes is incompatible with human life. We analyze the experience of our department in management of severe esophageal traumas. Materials and methods: Between 1970-2010, in thoracic surgery department there have been treated 311 cases of acute esophageral pathology: 227 cases with combustions (142 men and 85 women), 52 with foreign body ingestions (32 men and 20 women), 17 with Boerhaave syndrome (12 men and 5 women), 15 with iatrogenies. There was established the correlation between the mortality and surgical management components ( perforation-surgery period, location of esophageal injury etc.). Results: Esophageal perforation has been determined in 37 (12%) cases: 7 (18,90%) – chemical combustion of the esophagus; 15 (40,54%) – injury through ingestion of foreign bodies; 15 (40,54%) – iatrogenies. General letality from the total group of patients (311) was 12,54%: 27 deceases (11,89%) – from the combustion group; 5 deceases (10%) – from the foreign body injury group; 7 deceases (41,17%) – from the Boerhaave syndrome group. Conclusions: 1. The etiology of esophageal perforations is varied, and predominates the injury through foreign body ingestion and iatrogenies. 2. An excessive letality is remarked in the group of patients with Boerhaave syndrome, the fact that correlates with diagnostic and therapeutic deficiency in this cases. 3. The direct correlation between the time of the accident, determinating cause, trauma circumstances, location and type of the injury and instant medical assistance are factors that dictate the prognostic.