How long can esophagus break to be able to restore?
summary
Esophageal rupture can occur in blunt injury, sharp instrument injury and firearm injury, or spontaneous esophageal rupture due to severe vomiting. Serious mediastinal infection can be caused by the overflow of food containing various bacteria and reflux gastric digestive juice into the mediastinum. Let's share my experience with you.
How long can esophagus break to be able to restore?
Indications: severe mediastinal contamination, extensive tissue edema, liquefaction, necrosis, and inability to carry out primary esophageal repair were found during SRE thoracotomy. The patient's general condition was poor, and he was unable to undergo esophagectomy.
The T-tube needs to be placed for a long time (generally 21 days). If the T-tube is not placed properly, it can compress the aorta and other organs, causing corrosion damage and serious complications. So keep the T-tube away from the aorta. Along the way, the drainage tube can be fixed with 2 needles on the diaphragm with absorbable thin thread, which is easy to pull out. ② The inner diameter of T-shaped tube was more than 0.8cm to ensure smooth drainage. If there is no large-diameter T-tube, Naylor suggested splitting the end of Portex thoracic closed drainage tube 15.0 cm longitudinally to make a self-made T-tube. After longitudinal split, one arm was inserted into the stomach, and the upper end of the other was inserted into the esophageal lumen.
Indications: severe esophageal injury, esophageal wall necrosis more than 1 / 2 of the inner diameter; Esophageal malignant tumor with SRE: severe irreversible esophageal basic lesions, extensive mucosal erosion, ulcer and scar stenosis; Sre of middle and upper esophagus or lower esophagus spread to upper esophagus; Multiple SRE, etc. If the patient is in good condition and can tolerate the operation, it is the indication of esophagectomy.
matters needing attention
The patient loses the function of swallowing autonomously or swallowing will cause aspiration (bilateral recurrent laryngeal nerve injury); The rupture of SRE is too long (more than 10 cm), and two overlapping stents can seal the rupture, but there is no esophageal wall outside the stent, which can not heal by itself; Perforation of the upper esophagus, higher than the level of the first thoracic vertebrae; Sre accompanied with esophageal varices; The patient's vital signs are unstable and cardiac arrest may occur at any time.
