Endoscopic Stent Insertion versus Primary Operative Management for Spontaneous Rupture of the Esophagus (Boerhaave Syndrome): An International Study Comparing the Outcome
Endoscopic Stent Insertion versus Primary Operative Management for Spontaneous Rupture of the Esophagus (Boerhaave Syndrome): An International Study Comparing the Outcome
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内镜下支架置入与食管自发性破裂（布尔哈夫综合征）的主要手术治疗：比较结果的国际研究
DOI：
10.1177/000313481307900627
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
H. Stein
中科院分区：
文献类型：
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作者：
M. Schweigert;R. Beattie;N. Solymosi;K. Booth;A. Dubecz;A. Muir;Kerstin Moskorz;Rudolf J. Stadlhuber;D. Ofner;J. McGuigan;H. Stein
自发性食道破裂（布尔哈夫综合征）是一种极其罕见的危及生命的疾病。传统上，手术是治疗的首选。内窥镜支架置入提供了一个很有前途的选择。本研究的目的是比较初级手术治疗与内窥镜支架植入术的结果。英国和德国的食道外科大容量中心参与了这项回顾性研究。在英国中心，常规进行手术治疗（初级修复或手术引流）。内镜下支架置入是德国中心的主要治疗选择。仅包括非恶性自发性食管破裂（Boerhaave综合征）的患者。分析人口学特征、合并症、临床过程和结果。该研究包括38例患者，中位年龄为60岁。22例患者从破裂到治疗时间小于24小时。总死亡率为38人中的4人。诊断时间大于24小时与较高的死亡风险相关（优势比[OR]， 4.64； 95%可信区间[CI]， 0.33 ~ 265.79）。手术组(S)和内镜支架组(E)分别20例和13例。3例食管切除术不可避免，2例保守治疗。两组患者在年龄、诊断时间少于24小时、重症监护天数、住院时间、败血症、肾功能衰竭、缓慢呼吸脱机或合并症方面无显著差异。支架组13例患者中有11例最终必须进行手术干预（电视辅助胸外科手术、开胸手术、纵隔切开术），其中3例甚至需要重复手术。手术组再手术率为6 / 20。死亡率为2 / 13 (E), 1 / 20 (S)。支架组发生致命结局的几率是手术组的3.3倍（OR, 3.32; 95% CI， 0.15至213.98）。通过内窥镜支架置入治疗Boerhaave综合征在发病率、重症监护病房或住院时间方面没有优势，并且经常导致治疗失败，最终需要手术干预。此外，内窥镜支架置入术比初始手术治疗有更高的致命风险。
Spontaneous rupture of the esophagus (Boerhaave syndrome) is an extremely rare, life-threatening condition. Traditionally surgery was the treatment of choice. Endoscopic stent insertion offers a promising alternative. The aim of this study was to compare the results of primary surgical therapy with endoscopic stenting. A British and a German high-volume center for esophageal surgery participated in this retrospective study. At the British center, operative therapy (primary repair or surgical drainage) was routinely carried out. Endoscopic stent insertion was the primary treatment option at the German center. Only patients with nonmalignant, spontaneous rupture of the esophagus (Boerhaave syndrome) were included. Demographic characteristics, comorbidity, clinical course, and outcome were analyzed. The study comprises 38 patients with a median age of 60 years. Time between rupture and treatment was less than 24 hours in 22 patients. Overall mortality was four of 38. Diagnosis greater than 24 hours was associated with higher risk for fatal outcome (odds ratio [OR], 4.64; 95% confidence interval [CI], 0.33 to 265.79). The surgery (S) and the endoscopic stent group (E) included 20 and 13 cases, respectively. Esophagectomy was unavoidable in three cases and two were managed conservatively. There were no significant differences in age, time to diagnosis less than 24 hours, intensive care unit days, hospital stay, sepsis, renal failure, slow respiratory weaning, or presence of comorbidity between the two groups. In 11 of 13 in the stent group, operative intervention (video-assisted thoracic surgery, thoracotomy, mediastinotomy) was eventually mandatory and three of 13 even required repeated surgery. The rate of reoperation in the surgery group was six of 20. Mortality was two of 13 (E) versus one of 20 (S). The odds for fatal outcome were 3.3 times higher in the stent group than in the surgery group (OR, 3.32; 95% CI, 0.15 to 213.98). Management of Boerhaave syndrome by means of endoscopic stent insertion offers no advantage regarding morbidity, intensive care unit or hospital stay, and is associated with frequent treatment failure eventually requiring surgical intervention. Furthermore, endoscopic stenting shows a higher risk for fatal outcome than primary surgical therapy.