Yellin A, Schachter P, Lieberman Y
Department of Thoracic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Acta Chir Scand. 1989 Jun-Jul;155(6-7):337-40.
Spontaneous transmural esophageal perforation is a rare condition with high morbidity and mortality. It is traditionally associated with alcohol abuse. Experience of the syndrome at a large medical center in Israel, a country where alcohol is not a national problem, is reviewed, and eight cases are described. The clinical picture was varied and confusing, only one patient presenting with the classic triad of vomiting, chest pain and subcutaneous emphysema, though abdominal pain occurred in six cases. The diagnosis consequently was delayed (average 2.8 days) in three patients and two died undiagnosed. Contrast studies, when performed, were diagnostic. Early rupture (less than 24 hours) was treated with primary repair (n = 3). Late rupture (greater than 24 hours) was successfully managed by drainage alone (without esophageal exclusion) in three cases, but required long hospital stay (mean 52 days). Five of the six patients diagnosed ante mortem survived. Late reconstructive procedures were not required. The key to successful outcome is awareness of the condition, with early diagnosis and aggressive surgical intervention--repair or drainage.
自发性全层食管穿孔是一种发病率和死亡率都很高的罕见疾病。传统上它与酗酒有关。本文回顾了以色列一家大型医疗中心对该综合征的诊治经验，以色列并非一个酗酒成风的国家，文中描述了8例病例。临床表现多样且令人困惑，只有1例患者出现呕吐、胸痛和皮下气肿的典型三联征，不过6例患者出现了腹痛。因此，3例患者的诊断被延误（平均延误2.8天），2例患者未被诊断出来就死亡了。进行造影检查时可明确诊断。早期破裂（少于24小时）的3例患者接受了一期修复治疗。3例晚期破裂（超过24小时）的患者仅通过引流（未行食管旷置）就成功治愈，但住院时间较长（平均52天）。6例生前确诊的患者中有5例存活。无需后期重建手术。成功治疗的关键在于对该病的认识、早期诊断以及积极的手术干预——修复或引流。
