Vidarsdottir H, Blondal S, Alfredsson H, Geirsson A, Gudbjartsson T
Department of Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Thorac Cardiovasc Surg. 2010 Dec;58(8):476-80. doi: 10.1055/s-0030-1250347. Epub 2010 Nov 25.
Oesophageal perforation is a rare but life-threatening condition with a significant morbidity and mortality. In this retrospective, nationwide study, the results of oesophageal perforation are reported for a well defined cohort, with special emphasis on the incidence, aetiology and results of surgical treatment.
29 consecutive patients (16 males) were diagnosed with perforation of the oesophagus at Landspitali University Hospital between 1980 and 2007. Patients had a mean age of 61 years (range: 7 months-90 years). Type of surgery, complications and survival were recorded. Average follow-up was 76 months.
Age-standardised incidence of oesophageal perforation was 3.1/1,000,000 per year during the study period. Out of 29 patients diagnosed with oesophageal perforation, the diagnosis was missed in 5 cases (17%) and first made at autopsy. Iatrogenic injury was the most frequent cause (52%), followed by spontaneous perforation (24%) and foreign body ingestion (17%). Thoracic perforations were seen in 73% of patients, and 14 patients had an underlying oesophageal disease. Nineteen patients were treated surgically, in 16 cases with drainage of the mediastinum via thoracotomy and insertion of chest tubes. The median time from perforation to surgery was 6.5 h and median length of hospital stay was 15 days (range: 9-83). All surgically treated patients survived surgery, and the 5-year overall survival rate was 69%.
More than half of all oesophageal injuries in Iceland are caused by a iatrogenic injury. Mortality is significant and is related to a missed diagnosis. Patients treated surgically all survived surgery; however, complications were frequent and their hospital stay was long.
食管穿孔是一种罕见但危及生命的疾病，具有较高的发病率和死亡率。在这项全国性的回顾性研究中，报告了一组明确队列的食管穿孔结果，特别强调了发病率、病因及手术治疗结果。
1980年至2007年间，Landspitali大学医院连续有29例患者（16例男性）被诊断为食管穿孔。患者平均年龄为61岁（范围：7个月至90岁）。记录手术类型、并发症及生存情况。平均随访时间为76个月。
研究期间食管穿孔的年龄标准化发病率为每年3.1/100万。在29例诊断为食管穿孔的患者中，有5例（17%）漏诊，首次诊断在尸检时。医源性损伤是最常见的原因（52%），其次是自发性穿孔（24%）和异物摄入（17%）。73%的患者为胸段穿孔，14例患者有潜在的食管疾病。19例患者接受了手术治疗，16例通过开胸手术进行纵隔引流并插入胸管。从穿孔到手术的中位时间为6.5小时，中位住院时间为15天（范围：9 - 83天）。所有接受手术治疗的患者均存活，5年总生存率为69%。
冰岛超过一半的食管损伤是由医源性损伤引起的。死亡率较高，与漏诊有关。接受手术治疗的患者均存活；然而，并发症频繁，住院时间长。
