Đặc điểm tổn thương thủng thực quản gây áp xe trung thất được điều trị tại Bệnh viện Việt Đức

Abstract

Objective: The purpose of our study was to assess the treatment of mediastinal abscess due to esophageal perforation and to make recommendations. Subject and method: A prospective study was conducted on patients with mediastinal abscess due to perforation of the esophagus treated in Viet Duc Hospital from January 2016 to June 2018. The diagnosis criteria of mediatinal abscess was based on Estrera (1983) standard, classified by Endo S (1999). Result: A total of 33 cases, the average age was 51.48 ± 16.30 years with the youngest of 14 years old, and the oldest of 88 years old; men accounted for 78.8%. Locations of esophageal lesions: 57.6% in 1/3 upper, 27.3% in 1/3 middle and 15.1% in 1/3 lower. Causes of perforation: 72.7% of foreign bodies, 21.2% of pathology. Type I and IIa accounted for 25/33 (75.8%). Managements on emergency of esophagus included: Perforation isolation by nasogastric catheter or gastrostomy, esophageal repair in 3 cases, 2 with stent graft due to complications to aortic artery. No any case of esophageal fistula in 2 cases were inserted stent. Outcomes: 2 discharged to die and death in the hospital so the mortality was  accounting for 6.1%. Conclusion: Experiences with 33 cases of mediastinal abscess caused by perforation of the esophagus shown that most cases had superior or middle lesions and needed gastrotomy, and with inferior lession should make jejunostomy, the insertion of stent is considered if the lesion suspected to the vessels.