RESUMO
OBJECTIVE: To compare the results of endoscopic vacuum therapy (EVT) and open surgery for esophageal perforations. MATERIAL AND METHODS: The study included 60 patients with esophageal perforations between 2010 and 2022. The main group included 29 patients who underwent minimally invasive treatment with EVT, the control group - 31 patients after open surgical interventions. RESULTS: Pneumonia occurred in 21 (72%) and 14 (45%) patients (p=0.04), esophageal stenosis within the perforation zone - in 4 (13.8%) and 1 (3.2%) patient, respectively (p=0.188). Chronic esophageal fistulas were significantly more common in the control group (6 (20.7%) versus 15 (48.4%) patients, p=0.032). The overall duration of treatment (median) among survivors was significantly shorter in the main group: 33 (23; 48) versus 71.5 (59; 93.7) days (p=0.5). However, length of ICU-stay was slightly higher (11 (6; 16) versus 8.5 (5; 12.75) days, p=0.32). Mortality rate was 13.8% (n=4) and 29% (n=9), respectively (p=0.213). Minimally invasive technologies decreased the risk of fatal outcome by 10 times (OR 10.123, 95% CI 1.491-124.97, p=0.035) compared to traditional surgery. CONCLUSION: EVT in complex minimally invasive treatment of patients with mechanical esophageal injuries is an effective method significantly reducing mortality and duration of inpatient treatment compared to traditional surgical approach.
Assuntos
Traumatismos Abdominais , Fístula Esofágica , Perfuração Esofágica , Tratamento de Ferimentos com Pressão Negativa , Humanos , Perfuração Esofágica/diagnóstico , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , EndoscopiaRESUMO
Iatrogenic injuries of the esophagus and trachea are rare. However, these are life-threatening events due to severe complications. The authors report iatrogenic perforation of cervical esophagus with a long false passage in posterior mediastinum in an 83-year-old patient undergoing endoscopic retrograde cholangiopancreatography for choledocholithiasis. Post-intubation rupture of thoracic trachea was diagnosed early after suturing the defect of esophagus and drainage of mediastinum. Treatment strategy was analyzed and conservative management of tracheal injury was substantiated.
Assuntos
Perfuração Esofágica , Mediastinite , Humanos , Idoso de 80 Anos ou mais , Perfuração Esofágica/diagnóstico , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Traqueia/cirurgia , Traqueia/lesões , Mediastinite/diagnóstico , Mediastinite/etiologia , Mediastinite/cirurgia , Ruptura/diagnóstico , Ruptura/etiologia , Ruptura/cirurgia , Intubação Intratraqueal/efeitos adversos , Doença IatrogênicaRESUMO
OBJECTIVE: To analyze the treatment outcomes in patients with spontaneous esophageal rupture (SER). MATERIAL AND METHODS: The study included 106 patients with SER admitted to the Sklifosovsky Research Institute for the period from 1992 to 2015. The sample also included 91 patients who were referred from other hospitals. All patients were divided into 4 groups depending on surgical procedure: surgical drainage (Group I, n=19); suturing the esophageal defect without antireflux surgery (Group II, n=12); esophageal wall repair with fundoplication procedure (Group III, n=62); resection of the thoracic esophagus (Group IV, n=13). RESULTS: In the 1st group, complication rate was 100% and significantly exceeded these values in groups II, III, and IV (66.7%, 71%, and 69.2%, respectively; p=0.0318, p=0.0189, and p=0.0413). The length of hospital-stay was the lowest in group IV (mean 42 days) and group I (mean 55 days). Mortality rate in groups I, III and IV was 15-20% lower than in group II. Pneumonia and pleural empyema were significant predictors of poor outcome. Fundoplication improved postoperative outcomes in group III compared to group II. Resection of the thoracic esophagus performed in accordance with strict indications interrupts infectious process and shortens recovery period. Surgical drainage is followed by persistent contamination of mediastinum and pleural cavities that may quickly result a fatal outcome. CONCLUSION: A differentiated approach to SER treatment can reduce the risk of complications and mortality.
Assuntos
Serviços Médicos de Emergência , Perfuração Esofágica , Doenças do Mediastino , Academias e Institutos , Humanos , Ruptura EspontâneaRESUMO
A case report of successful surgical treatment of spontaneous rupture of the esophagus in a patient with chronic obstructive pulmonary disease, bronchial asthma and obesity is presented. Rupture of the esophagus occurred during a coughing without vomiting.
Assuntos
Tosse/etiologia , Doenças do Esôfago/cirurgia , Esôfago/lesões , Esôfago/cirurgia , Doença Pulmonar Obstrutiva Crônica/complicações , Doenças do Esôfago/etiologia , Humanos , Ruptura/etiologia , Ruptura Espontânea , Vômito/complicaçõesRESUMO
The comparative analysis of 56 immunograms of patients with mediastinitis, caused by the esophagus trauma is represented. The mean values of 9 immunologic parameteres (the so called "norm of the pathology") were set for patients with noncomplicated mediastinitis. A novel method of the immune status evaluation for the patients with the acute surgical conditions and SIRS has been suggested. If early applied, the method allows substantive immunotherapy for such patients.
Assuntos
Esôfago , Imunidade Humoral/efeitos dos fármacos , Imunoterapia/métodos , Mediastinite , Monitorização Imunológica/métodos , Adulto , Esôfago/lesões , Esôfago/cirurgia , Feminino , Humanos , Masculino , Mediastinite/etiologia , Mediastinite/imunologia , Mediastinite/terapia , Cuidados Pós-Operatórios/métodos , Período Pós-Operatório , Ruptura/complicações , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Síndrome de Resposta Inflamatória Sistêmica/prevenção & controle , Fatores de Tempo , Resultado do TratamentoAssuntos
Doenças do Esôfago , Esofagoplastia , Esôfago/lesões , Complicações Pós-Operatórias/prevenção & controle , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/etiologia , Doenças do Esôfago/cirurgia , Esofagoplastia/efeitos adversos , Esofagoplastia/métodos , Esôfago/patologia , Esôfago/cirurgia , Humanos , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Vômito/complicaçõesAssuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Tamponamento Cardíaco/cirurgia , Traumatismos Cardíacos , Ferimentos por Arma de Fogo/cirurgia , Ferimentos não Penetrantes , Adulto , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/fisiopatologia , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/fisiopatologia , Traumatismos Cardíacos/cirurgia , Humanos , Masculino , Radiografia , Ruptura/complicações , Ruptura/diagnóstico por imagem , Ruptura/fisiopatologia , Ruptura/cirurgia , Resultado do Tratamento , Ferimentos por Arma de Fogo/classificação , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/fisiopatologia , Ferimentos não Penetrantes/cirurgiaRESUMO
A correction to this article has been published and is linked from the HTML version of this paper. The error has been fixed in the paper.
RESUMO
It is shown that the local approximation for electron distribution function (EDF) determination at plasma periphery, where the ambipolar field is dominant, is not applicable even at high pressures when the characteristic plasma size exceeds the energy relaxation length of the electrons R > λ ε . Therefore, consistent results can be obtained only when solving the complete kinetic equation in both energy and spatial variables (i.e. it is necessary to solve nonlocal kinetic equation).