INVESTIGATION OF THE RELATED FACTORS ON THE FAILURE THE SURGICAL TREATMENT OF THE FORCEFUL VOMITTING OESOPHAGEAL RUPTURE IN CHO RAY - TRUNG VUONG EMERGENCY HOSPITAL, DURING 14 YEARS (1999-2012)
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Abstract
Objective: Oesophageal rupture with violent retching and vomiting is a potentially mortal
condition. Classically, the best condition is the primary repair for ruptures diagnosed early. Untill now, the recent opinions are different. The purpose of the study is analysis the clinical presentations, the results and the related factors on the failure of the surgical treatment of Boerhaave syndrome over a period of 14 years at two centers (Cho Ray and Trung Vuong hospital).
Methods: Nineteen patients were performed between january 1999 and january 2012. Mean age: 49 years, ranged from 36 to 64 years. The peak from 46 to 55 years old. All of them are men. All patients were confirmed by chest X- ray and computed tomography with contrast study swallow.
Results: The median postoperative stay was 36 days (range: 18-60 days). Mortality rate was 47% (9/19 patients). Nine patients underwent thoracotomy for primary oesophageal suture: All of them were suture line leakage and 5 died of septic shock during the first week). * Ten patients with late diagnosis and widespread inflammation from the perforation underwent thoracic drainage and continuted irrigation, 4 died: 3 of septic shock and one in state of cachexia. Six which secondary repaired thoracotomy, were good.
Conclusion: Although Boerhaave’s syndrome has a high mortality rate, primary adequate minimize surgical debridement (remove all of food remaints, the necrotic tissue) with mediastinal and pleural cavity drainage, combined with broad-spectrum antibiotics and good nutrition resulted a low mortality. Primary reconstructive surgery have an adverse effecton the daily life of these patients.
Article Details
Keywords
Boerhaave’s syndrome - Esophageal perforation - Thoracic esophageal surgery - Thracotomy - Video-assisted thoracoscopic surgery (VATS).
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