急性食管损伤的临床特点及经验总结（附61例报告）

Clinical characteristics of acute esophageal injury and summary of experience (61 cases)

摘要:

目的 分析急性食管损伤患者的临床特点，以提高临床医生对此类疾病的诊治水平。方法 回顾性分析2013年1月－2023年3月该院收治的163例急性食管损伤患者的临床资料和治疗方法，并进行总结分析。结果 最终纳入急性食管损伤患者61例。其中，食管贲门黏膜撕裂综合征54例，食管血肿4例，自发性食管破裂2例，食管血肿合并食管贲门黏膜撕裂综合征1例。食管贲门黏膜撕裂综合征患者大部分为男性（72.2%），年龄（52.04±17.96）岁，诱因为胃镜检查术的患者29例（53.7%），以呕血和黑便为主要表现（63.0%），平均住院时间（6.39±3.53）d，13例（24.1%）出现贫血并发症，输血8例（14.8%），39例（72.2%）经输液等保守治疗后出院，只有15例（27.8）需要行内镜下止血治疗。1例食管血肿合并食管贲门黏膜撕裂综合征，为老年男患者，有高血压和脑梗死病史，长期口服阿司匹林，并发重度贫血，内镜下给予去甲肾上腺素止血，术后经保守治疗，食管黏膜恢复良好，住院总时间为22 d。4例食管血肿患者均为中青年男性，2例发病前存在饮食不当的诱因，2例表现为呕血，1例出现胸痛，1例出现咽喉异物感，2例经内镜下干预，其余2例保守治疗后出院。2例自发性食管破裂患者均为中青年男性，临床表现为胸闷或胸骨后不适，1例食管破裂伴有左侧液气胸，行食管破裂修补术+胸膜粘连烙断术+开胸止血术+胸内异物清除术，术后内镜下放置食管支架，52 d后出院；另1例食管瘘口较小，在胃镜引导下置入三腔营养管，7 d后食管恢复良好，出院。结论 急性食管损伤是临床上的急危疾病，尤其是食管血肿和自发性食管破裂较为罕见，对于保守治疗失败的食管血肿破裂患者，及时行内镜血凝块清除是一种可行的方法，自发性食管破裂患者在外科手术后，于内镜下放置食管支架，黏膜恢复良好。临床医生需警惕食管损伤患者中并发贫血，甚至需要输血的患者，应早期明确诊断，及时通过内镜或手术干预来避免病情进展。

Abstract:

Objective To analyze the clinical characteristics of patients with acute esophageal injuries in order to improve clinicians' diagnosis and treatment of such diseases.Methods The general data and treatment methods of 61 patients with acute esophageal injury from January 2013 to March 2023 were retrospectively analyzed.Results Majority of the patients with esophageal and cardia mucosal tear syndrome were male (72.2%), age (52.04 ± 17.96) years, triggering factor was gastroscopy in 29 patients (53.7%), and vomiting of blood and black stools was the main clinical manifestation (63.0%), the average length of hospital stay was (6.39 ± 3.53) d and 13 (24.1%) patients had anaemic complications, blood transfusion was given to 8 patients (14.8%), 39 patients (72.2%) were discharged after conservative treatment with transfusion, and only 15 patients (27.8%) required endoscopic hemostasis. 1 case of esophageal hematoma combined with esophageal cardia mucosal tear syndrome was an elderly male patient with a history of hypertension, cerebral infarction, and long term use of oral aspirin, complicated by severe anemia, who was given desiprofloxacin to stop the hemostasis endoscopically, the total length of hospital stay was 22 d. 4 patients with esophageal hematoma were young and middle-aged males, 2 patients had a predisposing factor of poor diet prior to the onset of the disease, 2 patients presented with vomiting of blood, 1 with chest pain and 1 with a foreign body sensation in the throat, 2 patients were discharged with endoscopic intervention, and the remaining 2 patients were discharged after conservative treatment. 2 patients with spontaneous esophageal rupture were young and middle-aged males, clinical manifestations were chest tightness or retrosternal discomfort, and one patient had esophageal rupture with left-sided liquid pneumothorax, esophageal rupture repair+pleural adhesion branding+open thoracic hemostasis+intrathoracic foreign body removal was performed, and an esophageal stent was placed endoscopically after the operation, and the patient was discharged from the hospital after 52 d, in another case, the patient's esophageal fistula was small, and a three-lumen nutrient tube was placed under gastroscopic guidance, the patient's esophagus recovered well after 7 d, and the patient was discharged from the hospital.Conclusion Acute esophageal injury is a clinical emergency, among them, esophageal hematoma and spontaneous esophageal rupture are relatively rare. Prompt endoscopic clot removal is a viable option for patients with ruptured esophageal hematomas who have failed conservative treatment, and patients with spontaneous esophageal rupture who have surgically placed esophageal stents have good mucosal recovery. Clinicians need to be vigilant for patients with esophageal injuries that are associated with anemia, or even require blood transfusion, should make a clear diagnosis at an early stage, with timely endoscopic or surgical intervention to avoid progression of the disease.