Minimally invasive endoscopic therapy for the management of Boerhaave's syndrome.
Minimally invasive endoscopic therapy for the management of Boerhaave's syndrome.
复制标题
用于治疗布尔哈夫综合征的微创内窥镜治疗。
DOI：
10.1308/003588413x13629960049315
复制
发表时间：
2013
影响因子：
1.4
通讯作者：
H. Kasem
中科院分区：
文献类型：
--
作者：
J. Darrien;H. Kasem
介绍
布尔哈夫综合征是所有胃肠道穿孔中最致命的一种。2009年，基于目前的4级证据发表了一项治疗方案，表明所有脓毒症患者均应接受手术治疗，早期表现无脓毒症，内镜检查无脓毒症，延迟表现无脓毒症，保守治疗。没有为不适合手术治疗的脓毒症患者提供任何服务。通过一系列病例，我们展示了如何成功地使用微创内镜治疗来管理这样的队列。
方法
在2008年9月至2010年1月期间，有5名患有布尔哈夫综合征的患者到Wishaw综合医院就诊，所有患者都有相关的脓毒症特征，不适合手术。采用微创内镜治疗，包括食管支架内镜置入、视频辅助胸腔镜灌洗消除纵隔/胸膜污染、使用窦道内镜和经裂孔内镜引流的小剖腹术管理后续收集物，以及使用Surgisis®闭合食管皮肤瘘（Cook Surgical，布卢明顿，印第安纳州，美国）采用会合技术在内窥镜下定位肛瘘塞。
结果
在第50、50、51、59和103天，所有5例病例均实现了食管上皮再生和脓毒症消退。今天有四个病人还活着。第5例患者因合并症于第109天在医院死亡。2例患者因良性食管狭窄需要食管扩张。
结论
微创内镜治疗可以成功地用于实现食管上皮再生和解决败血症的患者不适合手术干预。它提供了一个可行的治疗患者没有占在今天的文献，并扩大了目前描述的内镜治疗。
INTRODUCTION
Boerhaave's syndrome represents the most lethal of all gastrointestinal perforations. In 2009 a treatment algorithm was published based on current level 4 evidence indicating that all septic patients should be treated surgically, early presentations without sepsis endoscopically and delayed presentations without sepsis conservatively. No provision was made for septic patients unfit for surgical intervention. Using a case series, we demonstrate how minimally invasive endoscopic therapies can be used successfully to manage such a cohort.
METHODS
Between September 2008 and January 2010, five patients presented to Wishaw General Hospital with Boerhaave's syndrome, all with an associated septic profile and none fit for surgery. They were managed using minimally invasive endoscopic therapies including endoscopic placement of oesophageal stents, elimination of mediastinal/pleural contamination using video assisted thorascopic lavage, management of subsequent collections using sinus tract endoscopy and mini-laparotomy with transhiatal endoscopic drainage, and closure of oesophagocutaneous fistulas using the Surgisis® (Cook Surgical, Bloomington, IN, US) anal fistula plug sited endoscopically with a rendezvous technique.
RESULTS
Oesophageal re-epithelialisation and resolution of sepsis was achieved in all five cases on days 50, 50, 51, 59 and 103. Four patients are alive today. The fifth died on day 109 in hospital as a consequence of co-morbidity. Two patients required oesophageal dilatation for benign oesophageal strictures.
CONCLUSIONS
Minimally invasive endoscopic therapy can be used successfully to achieve oesophageal re-epithelialisation and resolution of sepsis in patients unfit for surgical intervention. It offers a feasible treatment for patients not accounted for in today's literature and expands on currently described endoscopic therapies.