Glatz Torben, Marjanovic Goran, Kulemann Birte, Hipp Julian, Theodor Hopt Ulrich, Fischer Andreas, Richter-Schrag Hans-Jürgen, Hoeppner Jens
Department of Surgery, University of Freiburg, Freiburg, Germany.
Division of Interdisciplinary Endoscopy, Department of Internal Medicine II, University of Freiburg, Freiburg, Germany.
Dis Esophagus. 2017 Feb 1;30(3):1-6. doi: 10.1111/dote.12461.
Treatment of spontaneous esophageal perforation (SEP) consists of different conservative, surgical and endoscopic treatment modalities. In this study, we evaluated the clinical efficacy and the outcome of covered self-expanding stent (CSES) treatment of SEP. All patients with SEP treated by CSES at our institution between 2005 and 2014 were included in this prospective single-center study. The data were collected from a prospective database based on clinical, endoscopic and operative reports. Follow-up data were procured by contacting the patients or their family doctors. The patient data were analyzed concerning course of treatment, leakage sealing rate, complications, and mortality. Patients with iatrogenic or malignant perforations were excluded. In total, 16 patients underwent endoscopic CSES placement for SEP between 2005 and 2014. Sealing of the leakage was immediately successful in 50% (8 patients). A second stent was placed in 5 patients, but did not achieve sealing of the perforation in any case, requiring a switch in treatment to a surgical procedure (n=4) or drainage of the persisting leakage (n=4). In-hospital mortality was 13%. Only delayed treatment was identified as a risk factor for inferior outcome. Patients with successful CSES treatment had a shorter ICU- and hospital stay and had a reduced risk of developing esophageal stenosis (RR: 0.4) or persisting dysphagia despite treatment (RR: 0.33). Endoscopic treatment of SEP is beneficial to the patient if immediately successful, but in our experience, failure rates are higher than described in the literature. Secondary placement of CSES was not successful when initial stent treatment failed, while both surgical intervention and drainage of the perforation showed good results in sealing the leakage.
自发性食管穿孔（SEP）的治疗包括不同的保守、手术和内镜治疗方式。在本研究中，我们评估了覆膜自膨式支架（CSES）治疗SEP的临床疗效和结果。2005年至2014年期间在我院接受CSES治疗的所有SEP患者均纳入本前瞻性单中心研究。数据收集自基于临床、内镜和手术报告的前瞻性数据库。通过联系患者或其家庭医生获取随访数据。对患者数据进行分析，内容包括治疗过程、渗漏封闭率、并发症和死亡率。排除医源性或恶性穿孔患者。2005年至2014年期间，共有16例患者因SEP接受了内镜下CSES置入术。50%（8例患者）的渗漏立即成功封闭。5例患者置入了第二个支架，但在任何情况下均未实现穿孔封闭，需要将治疗改为手术（n = 4）或持续引流渗漏（n = 4）。住院死亡率为13%。仅发现延迟治疗是预后不良的危险因素。CSES治疗成功的患者在重症监护病房（ICU）和住院时间较短，发生食管狭窄（相对风险：0.4）或治疗后持续吞咽困难（相对风险：0.33）的风险降低。SEP的内镜治疗若立即成功对患者有益，但根据我们的经验，失败率高于文献报道。当初始支架治疗失败时，CSES的二次置入未成功，而手术干预和穿孔引流在封闭渗漏方面均显示出良好效果。
