Brinster Clayton J, Singhal Sunil, Lee Lawrence, Marshall M Blair, Kaiser Larry R, Kucharczuk John C
Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.
Ann Thorac Surg. 2004 Apr;77(4):1475-83. doi: 10.1016/j.athoracsur.2003.08.037.
Esophageal perforation remains a devastating event that is difficult to diagnose and manage. The majority of injuries are iatrogenic and the increasing use of endoscopic procedures can be expected to lead to an even higher incidence of esophageal perforation in coming years. Accurate diagnosis and effective treatment depend on early recognition of clinical features and accurate interpretation of diagnostic imaging. Outcome is determined by the cause and location of the injury, the presence of concomitant esophageal disease, and the interval between perforation and initiation of therapy. The overall mortality associated with esophageal perforation can approach 20%, and delay in treatment of more than 24 hours after perforation can result in a doubling of mortality. Surgical primary repair, with or without reinforcement, is the most successful treatment option in the management of esophageal perforation and reduces mortality by 50% to 70% compared with other interventional therapies.
食管穿孔仍然是一个灾难性事件，难以诊断和处理。大多数损伤是医源性的，预计未来几年内镜检查的使用增加会导致食管穿孔的发生率更高。准确的诊断和有效的治疗取决于对临床特征的早期识别以及对诊断性影像学的准确解读。预后取决于损伤的原因和部位、是否存在合并的食管疾病以及穿孔与开始治疗之间的时间间隔。与食管穿孔相关的总体死亡率可接近20%，穿孔后超过24小时延迟治疗可导致死亡率翻倍。手术一期修复，无论是否进行加固，是食管穿孔治疗中最成功的治疗选择，与其他介入治疗相比，可将死亡率降低50%至70%。
