Nashef S A, Klein C, Martigne C, Velly J F, Couraud L
Department of Thoracic Surgery, Xavier Arnozan Hospital, Pessac, France.
Eur J Cardiothorac Surg. 1992;6(10):565-7. doi: 10.1016/1010-7940(92)90010-u.
Over an 11-year period, 12 patients with foreign body perforation of a previously normal oesophagus were treated in our institution. The foreign bodies were most commonly bones (10 cases), 5 of which were chicken bones; other species were pigeon, rabbit, veal, pork and fish (one each); 2 perforations were due to swallowed dentures. The mean age was 60 years (range 42-73) and 6 patients were female. A degree of psychosocial dysfunction was present in 3 patients. Seven patients presented late (> 48 h after ingestion). The commonest presenting symptoms were fever and pain (8 patients). Other symptoms included dysphagia (7), respiratory distress (3), and late cervical abscess formation (3). The diagnosis was established by contrast oesophagography or rigid oesophagoscopy. A third of the perforations were cervical, the remainder intrathoracic. All patients were treated by surgical drainage with or without primary closure of the perforation. There were no operative deaths. Five patients developed postoperative oesophageal leaks which required reoperation in 1 patient. All patients were well and swallowing normally on discharge from hospital. Follow-up endoscopy or oesophagography was carried out in all patients and confirmed the absence of oesophageal disorders. Foreign body perforation of the oesophagus is a rare but important subentity of oesophageal perforation which responds well to surgical treatment.
在11年期间，我院共治疗了12例既往正常食管异物穿孔患者。异物最常见的是骨头（10例），其中5例是鸡骨头；其他种类有鸽子、兔子、小牛肉、猪肉和鱼（各1例）；2例穿孔是由于吞咽假牙所致。平均年龄为60岁（范围42 - 73岁），6例为女性。3例患者存在一定程度的社会心理功能障碍。7例患者就诊较晚（摄入异物后> 48小时）。最常见的症状是发热和疼痛（8例）。其他症状包括吞咽困难（7例）、呼吸窘迫（3例）和晚期颈部脓肿形成（3例）。通过食管造影或硬式食管镜检查确诊。三分之一的穿孔位于颈部，其余位于胸段。所有患者均接受手术引流，部分患者同时进行穿孔的一期缝合。无手术死亡病例。5例患者术后发生食管漏，其中1例需要再次手术。所有患者出院时情况良好，吞咽正常。所有患者均接受了随访内镜检查或食管造影，证实无食管疾病。食管异物穿孔是食管穿孔中一种罕见但重要的类型，手术治疗效果良好。
