Burnett C M, Rosemurgy A S, Pfeiffer E A
Department of Surgery, University of South Florida, Tampa, Florida 33606.
Ann Thorac Surg. 1990 Jun;49(6):979-83. doi: 10.1016/0003-4975(90)90882-7.
We analyzed the treatment of a recent group of patients with life-threatening acute posterior mediastinitis due to esophageal perforation to elucidate common factors in successful treatment. Life-threatening acute posterior mediastinitis due to esophageal perforation was diagnosed in 16 patients over the past 12 years. Esophageal perforation resulted from endoscopy in 11 patients, retching in 4, and blunt trauma in 1 patient. Preoperative serum albumin levels were higher in patients who survived. Fourteen of 16 patients (88%) underwent exploration: mediastinal drainage in 14 (10 survived), esophageal repair in 9 (7 survived) with diversion in 3 (3 survived), and stent placement in 2 (1 survived). Six of 16 patients (38%) died, always of polymicrobial sepsis. Female patients and those with cancer, endoscopic perforations, delayed diagnosis, persistent mediastinal contamination, mediastinal suppuration or necrotizing cellulitis, and postoperative complications did poorly. Antibiotics must be effective against both gram-positive and gram-negative bacteria, and against both anaerobic and aerobic bacteria. Early surgical intervention is key, particularly elimination of ongoing mediastinal soilage. Thorough mediastinal debridement and wide mediastinal drainage appear to be important in improving survival of patients with life-threatening acute posterior mediastinitis due to esophageal perforation.
我们分析了近期一组因食管穿孔导致危及生命的急性后纵隔炎患者的治疗情况，以阐明成功治疗的共同因素。在过去12年中，16例患者被诊断为因食管穿孔导致危及生命的急性后纵隔炎。11例患者的食管穿孔由内镜检查引起，4例由干呕引起，1例由钝性创伤引起。存活患者的术前血清白蛋白水平较高。16例患者中有14例（88%）接受了探查：14例进行了纵隔引流（10例存活），9例进行了食管修复（7例存活），其中3例进行了转流术（3例存活），2例置入了支架（1例存活）。16例患者中有6例（38%）死亡，均死于多微生物败血症。女性患者以及患有癌症、内镜穿孔、诊断延迟、纵隔持续污染、纵隔化脓或坏死性蜂窝织炎以及术后并发症的患者预后较差。抗生素必须对革兰氏阳性菌和革兰氏阴性菌均有效，且对厌氧菌和好氧菌均有效。早期手术干预是关键，尤其是消除持续的纵隔污染。彻底的纵隔清创和广泛的纵隔引流对于提高因食管穿孔导致危及生命的急性后纵隔炎患者的生存率似乎很重要。
