食管穿孔的急诊食管切除术：一种安全的选择。

Emergent Esophagectomy for Esophageal Perforations: A Safe Option.

作者信息

Seo Y David, Lin Jules, Chang Andrew C, Orringer Mark B, Lynch William R, Reddy Rishindra M

机构信息

University of Michigan Medical School, Ann Arbor, Michigan.

Section of General Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan.

出版信息

Ann Thorac Surg. 2015 Sep;100(3):905-9. doi: 10.1016/j.athoracsur.2015.04.055. Epub 2015 Jul 16.

DOI:10.1016/j.athoracsur.2015.04.055

PMID:26188974

Abstract

BACKGROUND

Esophageal perforation is an injury associated with high morbidity and mortality. Initial management ranges from observation to esophagectomy. The aim of this study was to evaluate the relative mortality and safety of emergent esophagectomy for acute esophageal rupture when compared with elective esophagectomies.

METHODS

We performed a retrospective review of a prospective esophagectomy database from a single institution from 1977 to 2013. Patients who were admitted for esophageal perforation and underwent esophagectomy were identified and compared with patients who underwent elective esophagectomy.

RESULTS

In all, 3,015 patients received an esophagectomy in elective and emergent settings; 90 esophagectomies were for acute injuries (52 for benign and 38 for malignant causes). A longer median length of stay was associated with emergent esophagectomy compared with elective esophagectomy (13 versus 10 days, p < 0.0001), and the complication rates were higher in the emergent group (51.1% versus 35.6%, p = 0.003). The survival rates at 30 days, 1 year, and 5 years after surgery were not significantly different between the emergent and nonemergent esophagectomy groups for patients with both benign and malignant underlying conditions. Within the emergent group, there was no difference in 30-day or 6-month survival based on benign or malignant causes, but a significant difference was seen at 1 year (85% for benign versus 65% for malignant, p = 0.025) and 5 years for survival (72% versus 21%, p < 0.001).

CONCLUSIONS

Emergent esophagectomy represents a safe option for the treatment of esophageal perforation, with mortality comparable to elective esophagectomy.

摘要

背景

食管穿孔是一种发病率和死亡率都很高的损伤。初始治疗范围从观察到食管切除术。本研究的目的是评估与择期食管切除术相比，急诊食管切除术治疗急性食管破裂的相对死亡率和安全性。

方法

我们对1977年至2013年来自单一机构的前瞻性食管切除术数据库进行了回顾性分析。确定因食管穿孔入院并接受食管切除术的患者，并与接受择期食管切除术的患者进行比较。

结果

共有3015例患者在择期和急诊情况下接受了食管切除术；90例食管切除术是针对急性损伤（52例为良性病因，38例为恶性病因）。与择期食管切除术相比，急诊食管切除术的中位住院时间更长（13天对10天，p<0.0001），且急诊组的并发症发生率更高（51.1%对35.6%，p=0.003）。对于良性和恶性基础疾病的患者，急诊和非急诊食管切除术组术后30天、1年和5年的生存率无显著差异。在急诊组中，基于良性或恶性病因的30天或6个月生存率无差异，但在1年时存在显著差异（良性为85%，恶性为65%，p=0.025），5年生存率也有显著差异（72%对21%，p<0.001）。