Okten I, Cangir A K, Ozdemir N, Kavukçu S, Akay H, Yavuzer S
Department of Thoracic Surgery, Ankara University Medical School, Turkey.
Surg Today. 2001;31(1):36-9. doi: 10.1007/s005950170217.
Despite recent advances in thoracic surgery, the management of esophageal perforation remains problematical and controversial. Thirty-one patients were treated for an esophageal perforation between 1986 and 1998. The esophageal perforation was iatrogenic in 25 cases, spontaneous in 2, traumatic in 2, and caused by a tumor and tuberculous lymphadenitis in 2 patients. There were 10 cervical, 19 thoracic, and 2 abdominal perforations. The interval from perforation to operation was less than 24h in 12 patients and more than 24h in 19 patients. The surgical procedures included a primary repair in 12 patients, a resection in 8, and conservative treatment with minor surgical approaches in 11. The mortality rate was 20% (4/20 patients) in the surgical treatment group and 45.5% (5/11 patients) in the conservative treatment with minor surgery group. The overall mortality was 29% (9/31 patients). The prognosis is thus concluded to depend on the cause and location of the perforation, the presence of underlying esophageal diseases, and the surgical procedure chosen.
尽管胸外科手术近年来取得了进展，但食管穿孔的治疗仍然存在问题且存在争议。1986年至1998年间，有31例患者接受了食管穿孔治疗。25例食管穿孔为医源性，2例为自发性，2例为外伤性，2例由肿瘤和结核性淋巴结炎引起。有10例颈段穿孔、19例胸段穿孔和2例腹段穿孔。12例患者穿孔至手术的间隔时间小于24小时，19例患者超过24小时。手术方式包括12例患者进行一期修复，8例进行切除，11例采用小手术方式进行保守治疗。手术治疗组的死亡率为20%（20例患者中有4例），小手术保守治疗组的死亡率为45.5%（11例患者中有5例）。总体死亡率为29%（31例患者中有9例）。因此得出结论，预后取决于穿孔的原因和部位、潜在食管疾病的存在以及所选择的手术方式。
