Gondal Ghous, Johnson Egil, Johannessen Hans-Olaf, Hofstad Bjørn
Gastrokirurgisk avdeling, Ullevål universitetssykehus, 0407 Oslo.
Tidsskr Nor Laegeforen. 2008 May 1;128(9):1050-2.
Esophageal perforation is a serious condition with a high mortality. Treatment is both surgical and conservative.
Records were retrospectively reviewed for 22 patients (17 men), with median age 64 (30-85) years, that had been treated for esophageal perforation at Ullevaal University Hospital in the period 2000-2006.
Perforation was cervical in two (9%) patients, thoracic in 19 (86%) and abdominal in 1 (5%) of the patient(s). The etiology was iatrogenic in 11 (50%) patients, emetic in 8 (36%) and caused by a foreign body in 3 (14%) patients. Five patients with an iatrogenic etiology had oesophageal cancer. Diagnosis after onset of symptoms was evident within 24 hours in 41% patients, during 24-72 hours in 14% and later than 72 hours in 45% of the patients. Half of the patients (11) were treated surgically, including two that had been initially treated conservatively. Five patients (23%) died of thoracic perforations during hospitalization and there were no other deaths. Median hospital stay was 54 (3-174) days. At the end of follow-up median survival was 113 (12-660) days and 10 of the 22 patients were dead (45%).
Our impression is that early surgery of oesophageal perforation in fit patients can improve the outcome.
食管穿孔是一种严重疾病，死亡率很高。治疗方法包括手术治疗和保守治疗。
回顾性分析了2000年至2006年期间在乌勒瓦尔大学医院接受食管穿孔治疗的22例患者（17例男性）的记录，患者年龄中位数为64岁（30 - 85岁）。
2例（9%）患者穿孔位于颈部，19例（86%）位于胸部，1例（5%）位于腹部。病因方面，医源性因素导致的有11例（50%），呕吐导致的有8例（36%），异物导致的有3例（14%）。11例医源性病因患者患有食管癌。41%的患者在症状出现后24小时内确诊，14%在24 - 72小时内确诊，45%在72小时后确诊。半数患者（11例）接受了手术治疗，其中2例最初接受了保守治疗。5例（23%）患者因胸部穿孔在住院期间死亡，无其他死亡病例。中位住院时间为54天（3 - 174天）。随访结束时，中位生存期为113天（12 - 660天），22例患者中有10例死亡（45%）。
我们的印象是，身体状况适合的患者早期进行食管穿孔手术可改善预后。
