Attar S, Hankins J R, Suter C M, Coughlin T R, Sequeira A, McLaughlin J S
Department of Surgery, University of Maryland Medical School and Hospital, Baltimore 21201.
Ann Thorac Surg. 1990 Jul;50(1):45-9; discussion 50-1. doi: 10.1016/0003-4975(90)90082-h.
The records of 64 patients with esophageal perforation treated since 1958 were reviewed. There were 19 cervical perforations, 44 thoracic perforations, and one abdominal perforation. Thirty-one perforations (48%) were due to injury from intraluminal causes. Twenty (31%) resulted from extraluminal causes: penetrating wounds, 11; blunt trauma, 3; and paraesophageal operations, 6. Eleven (17%) were spontaneous perforations, and two (3%) were caused by perforation of an esophageal malignancy. Ten (91%) of 11 patients with cervical perforations treated less than 24 hours after injury survived compared with 6 (75%) of 8 patients treated more than 24 hours after injury; hence 16 (84%) of the 19 patients in the cervical group survived. In the thoracic group, 19 patients were treated within 24 hours with 16 survivors (84%) compared with 25 patients treated beyond 24 hours with 12 survivors (48%); hence 28 (64%) of the 44 patients in the thoracic group survived. The patient with an abdominal perforation survived. Thirty patients underwent primary suture closure of the perforation, and 25 (83%) lived. Seventeen patients had drainage, and 10 (59%) lived. Total esophagectomy was performed in 9 patients, 7 (78%) of whom survived. Exclusion-diversion procedures were performed in 5 patients, and 1 (20%) survived.
回顾了自1958年以来接受治疗的64例食管穿孔患者的记录。其中有19例颈部穿孔、44例胸部穿孔和1例腹部穿孔。31例穿孔（48%）是由腔内原因导致的损伤引起。20例（31%）是由腔外原因导致：穿透伤11例；钝性创伤3例；食管旁手术6例。11例（17%）为自发性穿孔，2例（3%）是由食管恶性肿瘤穿孔引起。11例颈部穿孔患者中，受伤后24小时内接受治疗的10例（91%）存活，而受伤后24小时以上接受治疗的8例患者中有6例（75%）存活；因此，颈部组19例患者中有16例（84%）存活。在胸部组中，19例患者在24小时内接受治疗，16例存活（84%），而24小时后接受治疗的25例患者中有12例存活（48%）；因此，胸部组44例患者中有28例（64%）存活。腹部穿孔的患者存活。30例患者对穿孔进行了一期缝合，25例（83%）存活。17例患者进行了引流，10例（59%）存活。9例患者进行了全食管切除术，其中7例（78%）存活。5例患者进行了旷置转流手术，1例（20%）存活。
