1 Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2015 May;204(5):1115-9. doi: 10.2214/AJR.14.13614.
The purpose of this study is to investigate the incidence, management, and outcomes of esophageal perforation after fluoroscopic balloon dilation in 820 adult patients with esophageal diseases.
Between December 1990 and April 2014, a total of 820 adult patients (age range, 21-93 years) underwent 1869 fluoroscopic balloon dilation sessions (mean, 2.3 sessions/patient; range, 1-29 sessions/patient) for esophageal diseases. We retrospectively reviewed the prospectively collected medical records and images of these patients and collected the data of patients who developed esophageal perforations after fluoroscopic balloon dilation.
During this period, 12 patients (six men and six women; mean age, 51 years; age range, 28-69 years) developed perforations. The perforation rate was 1.5% per patient and 0.6% per dilation. Among the first eight patients, four who were treated with surgery had perforations 2 cm or larger, and the other four who underwent fasting, parenteral alimentation, and treatment with antibiotics had perforations smaller than 2 cm. The last four patients underwent stent placement immediately after the diagnosis, regardless of the perforation's size. The median hospital stay was 11.5 days.
Fluoroscopic balloon dilation of esophageal diseases is a safe procedure with a low perforation rate. A perforation size greater than 2 cm is considered large and requires aggressive treatment. Although the number of patients with esophageal perforation we treated is relatively small and further clinical trials are needed, temporary stent placement seems to be an initial choice in the management of esophageal perforations after fluoroscopic balloon dilation.
本研究旨在调查 820 例食管疾病患者行荧光透视球囊扩张后食管穿孔的发生率、处理方法和转归。
1990 年 12 月至 2014 年 4 月，共有 820 例成人患者（年龄 21-93 岁）接受了 1869 次荧光透视球囊扩张术（平均 2.3 次/例；范围 1-29 次/例）治疗食管疾病。我们回顾性分析了这些患者前瞻性收集的病历和影像资料，并收集了荧光透视球囊扩张后发生食管穿孔的患者数据。
在此期间，12 例患者（6 例男性和 6 例女性；平均年龄 51 岁；年龄范围 28-69 岁）发生穿孔。穿孔率为 1.5%/例和 0.6%/次。在前 8 例患者中，4 例接受手术治疗的患者穿孔直径≥2cm，另外 4 例接受禁食、肠外营养和抗生素治疗的患者穿孔直径＜2cm。后 4 例患者在诊断后立即进行支架置入，无论穿孔大小。中位住院时间为 11.5 天。
荧光透视球囊扩张治疗食管疾病是一种安全的方法，穿孔率较低。直径＞2cm 的穿孔被认为是大穿孔，需要积极治疗。尽管我们治疗的食管穿孔患者数量相对较少，需要进一步的临床试验，但临时支架置入似乎是荧光透视球囊扩张后食管穿孔处理的初始选择。
