Kết quả điều trị phẫu thuật áp xe trung thất do thủng thực quản tại Bệnh viện Hữu nghị Việt Đức

Abstract

Objective: To evaluate the results of surgical treatment of descending necrotizing mediastinitis (DNM) at Viet Duc Hospital. Subject and method: A prospective and retrospective study of cases diagnosed DNM due to perforation of the esophagus were treated in Viet Duc Hospital from 1/2016 to 3/2019 including the deaths and discharged to die. The diagnosis criterias of DNM was based on Estrera (1983) standard. The database is collected and analysed by SPSS 20.0. The proposal of study was agreed by the scientific committee of hospital. Result: A total of 39 cases, rate of man and women were 5.5:1, mostly ages were between 36 and 60 years old in 59%. Esophageal perforation caused by bone was in 88.5%. Location esophageal lesions: 1/3 upper in 57.5%, 1/3 middle in 22.5% and 20% accounted for one third lower part. Type I was 69.2%, and type IIb accounted for 30.8%. Surgical procedures: Pus drainage including drainage only 82.1%, by thoracotomy 17.9%. Drainage includes: Cervical drainage 40.6%, chest drainage 31.2%, cervical + chest drainage 28.1%. Thoracotomy in 7/39 cases including open surgery (06 cases) and VATs - Video Assisted Thoracotomies (01 cases). Isolation of esophageal perforation: 71% gastrostomy, and jejunostomy in 29%. Other procedures: 2 cases of vascular wound treatment, stent graft 02 cases due to arc aotic artery fistula to esophagus. Treatment results: Complications 7 cases (17.5%), death: 3 cases (7.5%). Conclusion: Surgical treatment of DNM on emergency due to perforation of the esophagus needs to drain pus, according to the position of the abscess, cervical drain and chest tube in combination, associated with the esophageal isolation by gastrostomy or jejunostomy.