Jungbluth T, Bouchard R, Kujath P, Bruch H-P
Klinik für Chirurgie des Universitätsklinikums Schleswig-Holstein, Campus Lübeck, D-23538 Lübeck, Germany.
Mycoses. 2005;48 Suppl 1:41-5. doi: 10.1111/j.1439-0507.2005.01110.x.
Perforations of the oesophagus are characterized by a high mortality rate, varying between 7 and 49%. In the analyzed group of patients between the years 1986 and 2003, the mortality rate of 28% was caused by septic complications such as mediastinitis and pneumonia. Microbiological examinations of samples from different locations and various secretions, detected mycoses in 28% of the patients (n = 16). Compared with the total of mycoses, a higher mortality of 50% was calculated. The invasive Candida infection of the oesophagus itself can cause a perforation. In perforations of the oesophagus, simultaneous mycoses arise by fungi invading sterile compartments or by haematogenous and lymphogenous dissemination up to sepsis. Uncomplicated courses do not need antimycotic therapy. At the beginning of the treatment, a microbiological monitoring should be provided, particularly with regard to the intraoperative facts. In relation to the course and the risk factors of the patients, an antimycotic therapy is initiated. Surgical clearing and sufficient drainage of the collateral compartments such as pleural and mediastinal compartments is highly significant.
食管穿孔的特点是死亡率高，在7%至49%之间波动。在1986年至2003年分析的患者组中，28%的死亡率是由纵隔炎和肺炎等感染性并发症引起的。对来自不同部位和各种分泌物的样本进行微生物学检查，在28%的患者（n = 16）中检测到真菌病。与真菌病总数相比，计算出的死亡率更高，为50%。食管本身的侵袭性念珠菌感染可导致穿孔。在食管穿孔中，真菌通过侵入无菌腔隙或通过血行和淋巴播散直至败血症而同时引发真菌病。非复杂性病程无需抗真菌治疗。在治疗开始时，应进行微生物学监测，特别是考虑到术中情况。根据患者的病程和危险因素，开始抗真菌治疗。对胸膜和纵隔等侧支腔隙进行手术清理和充分引流非常重要。
