Hermansson Michael, Johansson Jan, Gudbjartsson Tomas, Hambreus Göran, Jönsson Per, Lillo-Gil Ramon, Smedh Ulrika, Zilling Thomas
Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
BMC Surg. 2010 Oct 28;10:31. doi: 10.1186/1471-2482-10-31.
For many years there has been a debate as to which is the method of choice in treating patients with esophageal perforation. The literature consists mainly of small case series. Strategies for aiding patients struck with this disease is changing as new and less traumatic treatment options are developing. We studied a relatively large consecutive material of esophageal perforations in an effort to evaluate prognostic factors, diagnostic efforts and treatment strategy in these patients.
125 consecutive patients treated at the University Hospital of Lund from 1970 to 2006 were studied retrospectively. Prognostic factors were evaluated using the Cox proportional hazards model.
Pre-operative ASA score was the only factor that significantly influenced outcome. Neck incision for cervical perforation (n = 8) and treatment with a covered stent with or without open drainage for a thoracic perforation (n = 6) had the lowest mortality. Esophageal resection (n = 8) had the highest mortality. A CAT scan or an oesophageal X-ray with oral contrast were the most efficient diagnostic tools. The preferred treatment strategy changed over the course of the study period, from a more aggressive surgical approach towards using covered stents to seal the perforation.
Pre-operative ASA score was the only factor that significantly influenced outcome in this study. Treatment strategies are changing as less traumatic options have become available. Sealing an esophageal perforation with a covered stent, in combination with open or closed drainage when necessary, is a promising treatment strategy.
多年来，关于治疗食管穿孔患者的首选方法一直存在争议。文献主要由小病例系列组成。随着新的、创伤性较小的治疗选择不断发展，帮助患有这种疾病的患者的策略也在改变。我们研究了一组相对较大的连续性食管穿孔病例，以评估这些患者的预后因素、诊断方法和治疗策略。
对1970年至2006年在隆德大学医院接受治疗的125例连续性患者进行回顾性研究。使用Cox比例风险模型评估预后因素。
术前ASA评分是唯一显著影响预后的因素。颈部穿孔采用颈部切口（n = 8）以及胸部穿孔采用带或不带开放引流的覆膜支架治疗（n = 6）死亡率最低。食管切除术（n = 8）死亡率最高。CT扫描或口服造影剂的食管X线检查是最有效的诊断工具。在研究期间，首选的治疗策略发生了变化，从更积极的手术方法转向使用覆膜支架封闭穿孔。
术前ASA评分是本研究中唯一显著影响预后的因素。随着创伤性较小的选择出现，治疗策略正在改变。使用覆膜支架封闭食管穿孔，并在必要时结合开放或封闭引流，是一种有前景的治疗策略。
