Surgical Management of Esophageal Perforation: Role of Esophageal Conservation in Delayed Perforation
Surgical Management of Esophageal Perforation: Role of Esophageal Conservation in Delayed Perforation
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食管穿孔的手术治疗：食管保留在迟发性穿孔中的作用
DOI：
10.1177/000313480206800108
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
G. Pai
中科院分区：
文献类型：
--
作者：
G. Zumbro;M. Anstadt;K. Mawulawde;S. Bhimji;M. Paliotta;G. Pai
食管穿孔的连续性修复被认为是早期（<24小时）患者的首选治疗方法。然而，延迟就诊（>24小时）的最佳管理尚未得到很好的定义。本研究探讨了食管穿孔的处理，并比较了早期与延迟就诊的结局。回顾了诊断为食管穿孔的住院患者的记录。所有病例均经造影检查确诊。分析患者的人口统计学资料和结局，以确定早期和延迟就诊之间的差异。共发现22例食管穿孔病例（8例早期出现，14例延迟出现）。手术干预包括一期修复（4例）、肋间肌或胸膜瓣加固修复（14例）和食管完全切除（1例）。两名患者进行了清创和引流，没有修复，近端壁内撕裂用抗生素治疗和观察。两名患者在住院期间死亡。所有存活患者的食管功能恢复接近正常。3年随访显示胃肠道问题轻微。1例患者需要重复食管扩张，2例患者接受抗反流治疗。所有非恶性食管穿孔病例均应考虑食管修补术，且不应受出现时间的影响。
Definitive repair of esophageal perforation is considered the preferred treatment for patients presenting early (<24 hours). However, the optimal management of delayed presentation (>24 hours) has not been well defined. This study examined the management of esophageal perforation and compared the outcomes of early versus delayed presentation. Records of patients admitted with the diagnosis of esophageal perforation were reviewed. Contrast studies were used to confirm the diagnosis in all cases. Patient demographics and outcome were analyzed to determine differences between early and delayed presentation. A total of 22 cases of esophageal perforation were identified (eight early vs 14 delayed presentations). Operative interventions included primary repair (four), reinforced repair (14) either with intercostal muscle or pleural flap, and a complete esophageal resection (one). Debridement and drainage without repair were done in two patients and a proximal intramural tear was treated with antibiotics and observation. Two patients died during hospitalization. All surviving patients had near-normal restoration of esophageal function. Follow-up at 3 years has shown minimal gastrointestinal problems. One patient required repeat esophageal dilatations and two patients underwent antireflux therapy. Esophageal repair should be considered in all cases of nonmalignant esophageal perforation and should not be influenced by the time of presentation.