Successful Management of Boerhaave's Syndrome in Three Patients with Severe Comorbid Illness

Boerhaave氏症候群是一高致命性食道疾病，其死亡率從8%到60%不等。由於此症所呈現之身體症狀並不明確，而使得晚期診斷或誤診的機會超過50%。食道穿孔發生後24小時內，才能考慮做初級的修補。錯過此開刀之黃金時期，病患的預後將不樂觀。已經有幾篇的個案報告指出，保守療法在這類的病人身上仍然可行。然而，於文獻回顧並沒有任何一篇論及病患原本的身體疾病。因此，我們報告兩個肝硬化、一個尿毒症，且延遲就醫之Boerhaave氏症候群的病患，成功地以保守療法挽救其生命。我們的保守性療法包括：胸管引流，適當的抗生素，降胃酸治療，及儘早以十二指腸管灌營養治療。我們的結論是：延遲診斷的Boerhaave氏症候群患者，即使合併預後不佳的內科疾病，仍可能以保守療法成功挽救。先決條件是病患的敗血症症狀要輕，尚未到敗血性休克。

關鍵字

Boerhaave氏症候群；嚴重內科疾病；保守性療法

並列摘要

Boerhaave's syndrome is a highly lethal esophageal disease. Mortality rates vary from 8% to 60%. Late diagnosis or misdiagnosis occurs in more than 50% of patients because of the nonspecific presentation. Primary repair is considered only appropriate for patients diagnosed within 24 hours after esophageal perforation. Beyond this golden period, patients usually face poor results. Although there have been some cases that were reported to be treated successfully with conservative therapy, no discussion about the underlying diseases of those patients was presented. Herein, we report the cases of 2 cirrhotic patients and 1 uremic patient, all with delayed presentations of Boerhaave's syndrome who survived with intensive conservative management. Our conservative therapy consisted of intrathoracic drainage, adequate antibiotics, the decreasing of gastric acid secretion by H2 blockers or proton pump inhibitors, and early enteral alimentation by duodenal tube feeding. However, successful conservative therapy can only be possible in those with minimal symptoms and signs of sepsis, and without septic shock.

並列關鍵字

Boerhaave's syndrome ； severe comorbid illness ； conservative therapy

國際替代計量

Successful Management of Boerhaave's Syndrome in Three Patients with Severe Comorbid Illness

全文下載

主題瀏覽