Massey S R, Pitsis A, Mehta D, Callaway M
Sir Humphry Davy Department of Anaesthesia, Bristol Royal Infirmary, UK.
Br J Anaesth. 2000 May;84(5):643-6. doi: 10.1093/bja/84.5.643.
Transoesophageal echocardiography (TOE) is being used more often by cardiothoracic anaesthetists for the perioperative management of cardiac problems. Reports of iatrogenic oesophageal perforation by instrumentation of the oesophagus are increasing. Although TOE is considered safe, it may be more risky during surgery, because the probe is passed and manipulated in an anaesthetized patient. It may be in place for several hours so the risk of mucosal pressure and thermal damage is increased. Patients on cardiopulmonary bypass are also fully anticoagulated. We describe a case of oesophageal perforation following insertion of the TOE probe in a patient with gross cardiomegaly. Oesophageal distortion by cardiac enlargement may increase the risk of oesophageal perforation. Difficulty in passage of the TOE probe should be regarded with suspicion and withdrawal should be contemplated because the symptoms of oesophageal perforation are often delayed and non-specific. Delay in investigation, diagnosis and treatment will increase morbidity and mortality.
心胸麻醉医生在围手术期处理心脏问题时越来越多地使用经食管超声心动图（TOE）。关于食管器械操作导致医源性食管穿孔的报告日益增多。尽管TOE被认为是安全的，但在手术期间可能风险更高，因为探头是在麻醉患者体内通过和操作的。探头可能会放置数小时，因此黏膜受压和热损伤的风险增加。接受体外循环的患者也处于完全抗凝状态。我们描述了一例在患有明显心脏扩大的患者中插入TOE探头后发生食管穿孔的病例。心脏增大导致的食管变形可能会增加食管穿孔的风险。应怀疑TOE探头通过困难，并考虑撤回，因为食管穿孔的症状往往延迟出现且不具特异性。调查、诊断和治疗的延迟将增加发病率和死亡率。
