Nonoperative management of esophageal perforations - Is it justified?
Nonoperative management of esophageal perforations - Is it justified?
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DOI：
10.1097/00000658-199704000-00011
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发表时间：
1997-04-01
影响因子：
9
通讯作者：
Bohak, A
中科院分区：
文献类型：
--
作者：
Altorjay, A;Kiss, J;Bohak, A
目的介绍非手术治疗（NOT）的经验，即完全禁止每次口服食物摄入至少7天，广谱抗生素联合使用和肠外高营养，以治疗食管穿孔。背景资料NOT在食管穿孔治疗中的地位、价值和适应症尚未明确定义。因此，关于NOT的结果发表了相互矛盾的数据。方法近15年来（1979 ~ 1994年）86例食管穿孔患者中，20例（23.3%）从一开始就采用非手术治疗。在该组中，穿孔位于食道的上、中、下三分之一的比例分别为50%、30%和20%。在手术管理组（OT）中，采用保守（引流，假体内修复），重建（缝合，加强缝合）和根治性（切除）手术方法，病变主要位于食管的下三分之一（56.1% - 37/66）。从穿孔到开始治疗的时间间隔来看，14例患者在24小时内被诊断出来，6例患者在24小时后才开始治疗。结果16例患者均能成功进行体外循环；在另外4个案例中，使用NOT的决定需要修改（表1）。2名患者死亡；死亡率为10%（2 / 20）。非手术组的并发症发生率（20%，即20例中的4例）低于OT组（50%，即66例中的33例）。结论非织造术可用于治疗壁内穿孔。在跨壁穿孔的情况下，如果食道病变是限定的，不在肿瘤组织中，不在腹腔中，并且没有同时伴有阻塞性食道疾病，则应考虑这种入路；此外，应该没有败血症的症状和体征。
ObjectiveExperiences obtained with nonoperative treatment (NOT), i.e. total prohibition of per oral food intake for a minimum of 7 days, administration of combinations of broad-spectrum antibiotics, and parenteral hyperalimentation, are described in the management of esophageal perforations.Summary Background DataThe place, value, and indication of NOT in the management of esophageal perforation has not yet been unequivocally defined. As a result, contradictory data have been published regarding the outcome of NOT.MethodsDuring the past 15 years (1979 to 1994), 20 of 86 patients (23.3%) with esophageal perforation have been treated nonoperatively from the outset. in this group, perforations were located to the upper, middle, and lower third of the esophagus in 50%, 30%, and 20%, respectively. In the operative management group (OT)-in which conservative (drainage, endeprothesis), reconstructive (suture, reinforced suture), and radical (resection) surgical methods were applied-lesions were preponderantly located in the lower one third of the esophagus (56.1% - 37/66). As to the interval between the perforation and the onset of treatment, 14 patients had been diagnosed within 24 hours, whereas in 6 cases treatment had been begun beyond 24 hours.ResultsNOT could be successfully carried out in 16 patients; the decision to use NOT had to be revised in 4 other cases (Table 1). Two patients were lost; the mortality rate was 10% (2 Of 20). The rate of complications was lower in the NOT group (20%, or 4 of 20) than in the OT group (50%, or 33 of 66).ConclusionsNOT can be suggested for the treatment of intramural perforations. In the case of transmural perforation, this approach should be taken into consideration if the esophageal lesion is circumscribed, is not in neoplastic tissue, is not in the abdominal cavity, and is not accompanied by simultaneous obstructive esophageal disease; in addition, symptoms and signs of septicemia should be absent.