Zimmermann M, Hoffmann M, Jungbluth T, Bruch H P, Keck T, Schloericke E
1 Department of Surgery, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany.
2 Department of Surgery, Klinikum Wolfsburg, Wolfsburg, Germany.
Scand J Surg. 2017 Jun;106(2):126-132. doi: 10.1177/1457496916654097. Epub 2016 Jun 22.
Esophageal perforation is a life-threatening disease. Factors impacting morbidity and mortality include the cause and site of the perforation, the time to diagnosis, and the therapeutic procedure. This study aimed to identify risk factors for morbidity and mortality after esophageal perforation.
This retrospective study analyzed data collected from all patients treated for esophageal perforation at the Department of Surgery, University of Schleswig-Holstein, Luebeck Campus, from January 1986 through December 2011.
Altogether, 80 patients (52 men, 28 women; mean age 65 years) were treated. The cause of perforation was intraluminal in 44 (55%) (group A) and extraluminal in 2 (3%) (group B). Spontaneous perforations were observed in 12 (15%) (group C). Perforations were due to a preexisting esophageal disease in 22 (28%) (group D). The survival rate was higher for group A (82%) than for groups B (50%), C (57%), and D (59%). The distal third of the esophagus had the highest prevalence of perforations (49, 61%) independent of the cause. Mortality, however, was independent of the perforation site. Perforations were diagnosed within 24 h in 57% (n = 46) of patients, associated with a statistically significant lower mortality rate (p = 0.035). Altogether, 40 patients underwent non-operative treatment, and among those 27 had endoscopic treatment. Emergency thoracic surgery was performed in 40 patients: direct suture of the defect (n = 26), partial esophageal resection (n = 11), other (n = 3). Significantly higher morbidity (p = 0.007) and prolonged hospitalization (p < 0.0001) was observed among patients who underwent emergency surgery. Mortality was higher in the surgical group (14/40) than in the non-operative treatment group (9/40) but without statistical significance.
Intraluminal perforations, rapid initiation of therapy, and non-operative treatment were associated with favorable outcomes. The perforation site did not have an impact on outcomes. Esophageal resection was associated with high mortality.
食管穿孔是一种危及生命的疾病。影响发病率和死亡率的因素包括穿孔的原因和部位、诊断时间以及治疗方法。本研究旨在确定食管穿孔后发病率和死亡率的危险因素。
这项回顾性研究分析了1986年1月至2011年12月在吕贝克校区石勒苏益格 - 荷尔斯泰因大学外科接受食管穿孔治疗的所有患者的收集数据。
共治疗了80例患者（52例男性，28例女性；平均年龄65岁）。穿孔原因是腔内的有44例（55%）（A组），腔外的有2例（3%）（B组）。观察到12例（15%）自发性穿孔（C组）。22例（28%）穿孔是由先前存在的食管疾病引起的（D组）。A组的生存率（82%）高于B组（50%）、C组（57%）和D组（59%）。食管远端三分之一的穿孔发生率最高（49例，61%），与病因无关。然而，死亡率与穿孔部位无关。57%（n = 46）的患者在24小时内被诊断出穿孔，其死亡率在统计学上显著较低（p = 0.035）。共有40例患者接受了非手术治疗，其中27例接受了内镜治疗。40例患者接受了急诊胸外科手术：缺损直接缝合（n = 26）、部分食管切除术（n = 11）、其他（n = 3）。接受急诊手术的患者发病率显著更高（p = 0.007）且住院时间延长（p < 0.0001）。手术组的死亡率（14/40）高于非手术治疗组（9/40），但无统计学意义。
腔内穿孔、快速开始治疗和非手术治疗与良好的预后相关。穿孔部位对预后没有影响。食管切除术与高死亡率相关。
