MD, Associate Professor, Head of the Department of Surgical Diseases of Children and Adults FSBEI HE SamSMU MOH Russia, Chief Medical Officer of the Samara Regional Clinical Hospital named after V.D. Seredavin
Доктор медицинских наук, доцент, заведующий кафедрой хирургических болезней детей и взрослых Самарского государственного медицинского университета;
Главный врач Самарской областной клинической больницы им. В.Д. Середавина
MD, Professor of the Department of Surgical Diseases of Children and Adults FSBEI HE SamSMU MOH Russia
доктор медицинских наук, профессор кафедры хирургических болезней детей и взрослых ФГБОУ ВО СамГМУМинздрава России
thoracic surgeon of the Samara Regional Clinical Hospital named after V.D. Seredavin
врач-торакальный хирург ГБУЗ «Самарская областная клиническая больница им. В.Д. Середавина
thoracic surgeon of the Samara Regional Clinical Hospital named after V.D. Seredavin
врач-торакальный хирург ГБУЗ «Самарская областная клиническая больница им. В.Д. Середавина
Rationale. Esophageal injuries are accompanied by high lethality. The results of treatment are associated with the timing of diagnosis, methods of operations and their volume. Existing contradictions in the treatment of patients with oesophageal defects cause the relevance of this problem and the need to obtain additional data on factors affecting the outcome of the disease.
Purpose. Rationale for choosing a method of surgery for esophageal injuries, depending on the cause and time of diagnosis.
Methods. A comparative analysis of the examination and treatment of 195 patients with esophageal injuries who were being treated from 2012 to 2020 was carried out at the Samara Regional Clinical Hospital named after V.D. Seredavin. To confirm the diagnosis, a contrast study of the esophagus with water-soluble drugs and barium sulfate was carried out, esophagoscopy, bronchoscopy and computed tomography were performed according to the indications. An analysis of the dependence of deaths on the time of development of complications and the volume of surgery was carried out.
Results. Of the 91 patients operated with esophageal damage, 29 patients due to wall necrosis along the rupture line underwent through drainage of the injury area and the application of inducing sutures to the esophagus before drainage, 7 died. Of the 32 trauma patients, 3 (9.4%) died in the cervical esophagus, and 17 (28.8%) died in the thoracic and abdominal departments out of 59. A total of 20 (22%) died. The most severe injuries in patients occurred as a result of bouling and balloon dilation of the esophagus, of 7 3 patients died. An analysis of the dependence of deaths on the time of development of a complication before diagnosis showed that 24 hours died before 2. 24 - 48 hours - 3, more than 48 hours - 15. In 36 patients, primary surgery for esophageal injury was performed by cervical access, 4 died; in 39 - laparotomic (laparoscopic), 7 died; in 16 - thoracotomous, 5 died. When applying primary sutures to the wall of the esophagus, out of 12 patients, 2 died; in case of through drainage of the damage area of 29-7; when suturing the esophagus with strengthening of the damage zone m. sternocleidomastoideus on the feeding leg of 15-2; when suturing the esophagus with strengthening the area of damage to the bottom of the stomach - with a fundoplication cuff of 32-5; with esophageal resection from 3-1.
Conclusion. Esophageal injuries in 24.9% of patients are associated with diagnostic and treatment interventions. The choice of methods of surgery to eliminate damage in the esophagus is individual in nature and should be based on taking into account the factors that allow you to get a positive result.