Steinman E, Utiyama E M, Pires P W, Birolini D
Serviço de Cirurgia de Emergéncia, Faculdade de Medicina, Universidade de São Paulo.
Rev Hosp Clin Fac Med Sao Paulo. 1990 May-Jun;45(3):127-31.
Thirty four (75.5%) individuals sustained gunshot wounds, nine (20%) stab wounds, while two (4.4%) suffered blunt trauma. Thirty four patients (75%) displayed severance of the cervical portion of the esophagus, seven (15.5%) of the thoracic segment and only four (8.8%) had injuries on the abdominal portion. The cervical esophagus was surgically approached through oblique left side cervicotomy with primary suture and drainage with Penrose drain. A postero-lateral right side thoracotomy was employed for lesions of the upper and intermediate portion of the thoracic esophagus. When the lower portion of the esophagus was injured, a left side thoracotomy was employed. When the injury involved less than half of the perimeter of the esophagus suturing with ample drainage was adopted. In more extensive injuries involving over half of the perimeter total esophagectomy was the treatment of choice. In abdominal esophageal injuries laparotomy, suture and drainage were performed. Complications occurred in 40% of all patients. Seven patients died though only one from direct consequences of the esophageal injury. The authors believe that an early surgical approach for traumatic esophageal injuries is the best procedure. Primary suture and drainage score the best results. Other measures (esophagectomy, esophagostomy, gastrostomy) should be adopted only when the injury is either extensive or mediastinal contamination is present.
34例（75.5%）为枪伤，9例（20%）为刺伤，2例（4.4%）为钝器伤。34例患者（75%）表现为食管颈部离断，7例（15.5%）为胸段离断，仅4例（8.8%）腹部食管有损伤。颈部食管损伤通过左侧颈部斜切口手术入路，采用一期缝合并用橡皮引流管引流。胸段食管上、中段损伤采用右侧后外侧开胸术。食管下段损伤时，采用左侧开胸术。当食管损伤累及周长不到一半时，采用充分引流的缝合术。对于累及周长超过一半的更广泛损伤，首选治疗方法是全食管切除术。腹部食管损伤行剖腹术、缝合和引流。40%的患者发生了并发症。7例患者死亡，不过只有1例死于食管损伤的直接后果。作者认为，创伤性食管损伤早期手术治疗是最佳方法。一期缝合和引流效果最佳。只有在损伤广泛或存在纵隔污染时，才应采用其他措施（食管切除术、食管造口术、胃造口术）。
