Muir A D, White J, McGuigan J A, McManus K G, Graham A N
Department of Thoracic Surgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
Eur J Cardiothorac Surg. 2003 May;23(5):799-804; discussion 804. doi: 10.1016/s1010-7940(03)00050-2.
The diagnosis and management of oesophageal perforation continues to challenge clinicians. We present our experience of perforated oesophagus in a Tertiary Referral Centre for Thoracic and Oesophageal Surgery.
Between 1985 and 2000, 75 patients (40 male) with oesophageal perforation were treated in out unit; age range 24-89, median 63. Retrospective review of these cases has been performed.
There were 12 deaths (16%). With increases in time from perforation to diagnosis, there was a stepwise increase in the mortality rate. Immediate diagnosis 5%; early diagnosis (1-24h) 14%; late diagnosis (>24h) 44% (P>or=0.002). Site of perforation, aetiology, and treatment strategy had no influence on mortality. The only independent predictor of mortality identified was time to diagnosis from perforation (beta 0.429, P=0.001). Time to definitive management in those undergoing an operative procedure had no influence on outcome with multivariate analysis.
Prompt recognition of the diagnosis of oesophageal perforation and rapid institution of supportive measures, followed by an appropriate, patient specific treatment option optimises the chance of a successful outcome. The wide range of presentation of oesophageal perforation necessitates individualisation of treatment.
食管穿孔的诊断与处理仍然是临床医生面临的挑战。我们介绍在一家胸科和食管外科三级转诊中心处理食管穿孔的经验。
1985年至2000年间，我们科室共治疗了75例食管穿孔患者（40例男性）；年龄范围为24至89岁，中位数为63岁。对这些病例进行了回顾性分析。
有12例死亡（16%）。随着从穿孔到诊断的时间增加，死亡率逐步上升。即时诊断的死亡率为5%；早期诊断（1 - 24小时）为14%；晚期诊断（>24小时）为44%（P≥0.002）。穿孔部位、病因和治疗策略对死亡率无影响。唯一确定的死亡率独立预测因素是从穿孔到诊断的时间（β 0.429，P = 0.001）。多因素分析显示，接受手术治疗患者的确定性治疗时间对预后无影响。
迅速识别食管穿孔的诊断并迅速采取支持措施，随后选择合适的、针对患者个体的治疗方案，可优化成功治疗的机会。食管穿孔的表现形式多样，因此治疗需要个体化。
