Personal management of 57 consecutive patients with esophageal perforation
Personal management of 57 consecutive patients with esophageal perforation
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DOI：
10.1016/j.amjsurg.2002.11.004
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发表时间：
2004-01-01
影响因子：
3
通讯作者：
Kaman, L
中科院分区：
文献类型：
--
作者：
Gupta, NM;Kaman, L
背景：食道穿孔是一种外科急症，发病率和死亡率都很高。对于这种危及生命的疾病的适当处理尚无共识。方法：对1986年9月至2001年12月在印度昌迪加尔医学教育与研究生院外科治疗的57例食管穿孔患者进行回顾性分析。44例（77%）穿孔是由于医源性原因，6例患者（11%）发生自发性穿孔。异物吞入致穿孔4例（7%），钝伤2例（4%），腐蚀伤1例。共有6例（11%）患者发生颈部损伤，49例（86%）患者发生胸部损伤，1例患者发生腹部食管损伤。33例（58%）患者接受了紧急食管切除术，4例（7%）患者接受了一期修复术，4例（7%）患者接受了单纯引流，而16例（28%）患者接受了非手术治疗。使用这些治疗原则，我们实现了所有患者86%的生存率。8例（14%）患者死亡。自发性食管穿孔死亡率最高（67%）。治疗主要取决于两个因素：健康食管穿孔，以及先前存在的内在食管疾病导致远端梗阻的穿孔。食管穿孔伴狭窄病变（良性或恶性）需要食管摘除术。如果早期发现健康食管穿孔，应采用一期缝合治疗。晚期食管穿孔宜采用非手术保守治疗。(C)2004 Excerpta Medica，Inc. All rights reserved.
Background: Esophageal perforation is a surgical emergency associated with high morbidity and mortality. There is no consensus regarding the appropriate management of this life-threatening condition.Methods: A retrospective review was made of 57 patients with esophageal perforations treated at the Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India, between September 1986 and December 2001.Results: Forty-four (77%) perforations were due to iatrogenic causes, spontaneous perforations occurred in 6 patients (11%). Foreign body ingestion caused perforation in 4 (7%), followed by blunt trauma in 2 (4%) and caustic injury in 1 patient. A total of 6 (11%) patients had cervical injury, 49 (86%) patients had thoracic, and 1 patient had abdominal esophageal injury. Thirty-three (58%) patients underwent emergency esophagectomy, 4 (7%) patients underwent primary repair, and 4 patients (7%) underwent drainage alone, whereas 16 (28%) patients were managed by nonoperative treatment. Using these treatment principles, we achieved 86% survival rate for all patients. Eight (14%) patients died. Spontaneous perforation had the highest mortality (67%).Conclusions: Esophageal perforation needs aggressive treatment. The treatment depends mainly on two factors: perforation in a healthy esophagus, and perforation with a preexisting underlying intrinsic esophageal disease causing distal obstruction. Esophageal perforation associated with stenotic lesions (benign or malignant) needs esophageal extirpation. Perforation in a healthy esophagus should be treated by primary closure if encountered early. Nonoperative conservative treatment is appropriate when esophageal perforation is encountered late. (C) 2004 Excerpta Medica, Inc. All rights reserved.