Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
J Visc Surg. 2010 Jun;147(3):e117-28. doi: 10.1016/j.jviscsurg.2010.08.003. Epub 2010 Sep 15.
The incidence of esophageal perforation (EP) has risen with the increasing use of endoscopic procedures, which are currently the most frequent causes of EP. Despite decades of clinical experience, innovations in surgical technique and advances in intensive care management, EP still represents a diagnostic and therapeutic challenge. EP is a devastating event and mortality hovers close to 20%. Ambiguous presentations leading to misdiagnosis and delayed treatment and the difficulties in management are responsible for the high morbidity and mortality rates. A high variety of treatment options are available ranging from observational medical therapy to radical esophagectomy. The potential role of interventional endoscopy and the use of stents for the treatment of EP seem interesting but remain to be evaluated. Surgical primary repair, with or without reinforcement, is the preferred approach in patients with EP. Prognosis is mainly determined by the cause, the location of the injury and the delay between perforation and initiation of therapy.
食管穿孔（EP）的发病率随着内镜检查的广泛应用而上升，目前内镜检查是 EP 最常见的原因。尽管有几十年的临床经验，外科技术的创新和重症监护管理的进步，EP 仍然是一个诊断和治疗的挑战。EP 是一种毁灭性的事件，死亡率接近 20%。导致误诊和延迟治疗的临床表现不明确，以及管理上的困难，是高发病率和死亡率的原因。有各种各样的治疗选择，从观察性的药物治疗到根治性的食管切除术。介入内镜治疗和使用支架治疗 EP 的潜在作用似乎很有意义，但仍有待评估。对于 EP 患者，外科初次修复术，无论是否有加固，都是首选方法。预后主要取决于病因、损伤部位和穿孔与开始治疗之间的时间延迟。
