Law T T, Chan J Yl, Chan D Kk, Tong D, Wong I Yh, Chan F Sy, Law S
Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Hong Kong Med J. 2017 Jun;23(3):231-8. doi: 10.12809/hkmj164942. Epub 2017 Mar 10.
The mortality rate after oesophageal perforation is high despite advances in operative and non-operative techniques. In this study, we sought to identify risk factors for hospital mortality after oesophageal perforation treatment.
We retrospectively examined patients treated for oesophageal perforation in a university teaching hospital in Hong Kong between January 1997 and December 2013. Their demographic and clinical characteristics, aetiology, management strategies, and outcomes were recorded and analysed.
We identified a cohort of 43 patients treated for perforation of the oesophagus (28 men; median age, 66 years; age range, 30-98 years). Perforation was spontaneous in 22 (51.2%) patients (15 with Boerhaave's syndrome and seven with malignant perforation), iatrogenic in 15 (34.9%), and provoked by foreign body ingestion in six (14.0%). Of the patients, 14 (32.6%) had pre-existing oesophageal disease. Perforation occurred in the intrathoracic oesophagus in 30 (69.8%) patients. Emergent surgery was undertaken in 23 patients: 16 underwent primary repair, six surgical drainage or exclusion, and one oesophagectomy. Twenty patients were managed non-operatively, 13 of whom underwent stenting. Two stented patients subsequently required oesophagectomy. Four patients had clinical signs of leak after primary repair: two were treated conservatively and two required oesophagectomy. Overall, six (14.0%) patients required oesophagectomy, one of whom died. Nine other patients also died in hospital; the hospital mortality rate was 23.3%. Pre-existing pulmonary and hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality (P=0.03, <0.01, and <0.01, respectively).
Most oesophageal perforations were spontaneous. Mortality was substantial despite modern therapies. Presence of pre-existing pulmonary disease, hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality. Salvage oesophagectomy was successful in selected patients.
尽管手术和非手术技术有所进步，但食管穿孔后的死亡率仍然很高。在本研究中，我们试图确定食管穿孔治疗后医院死亡的危险因素。
我们回顾性研究了1997年1月至2013年12月期间在香港一家大学教学医院接受食管穿孔治疗的患者。记录并分析了他们的人口统计学和临床特征、病因、治疗策略及结果。
我们确定了一组43例接受食管穿孔治疗的患者（28例男性；中位年龄66岁；年龄范围30 - 98岁）。22例（51.2%）患者的穿孔为自发性（15例患有博雷尔综合征，7例为恶性穿孔），15例（34.9%）为医源性，6例（14.0%）由异物摄入引起。其中14例（32.6%）患者有既往食管疾病。30例（69.8%）患者的穿孔发生在胸段食管。23例患者接受了急诊手术：16例行一期修复，6例行手术引流或旷置，1例行食管切除术。20例患者接受非手术治疗，其中13例接受了支架置入术。2例接受支架置入术的患者随后需要行食管切除术。4例患者在一期修复后出现渗漏临床体征：2例保守治疗，2例需要行食管切除术。总体而言，6例（14.0%）患者需要行食管切除术，其中1例死亡。另外9例患者也在医院死亡；医院死亡率为23.3%。既往肺部和肝脏疾病以及与恶性肿瘤相关的穿孔与医院死亡率显著相关（分别为P = 0.03、<0.01和<0.01）。
大多数食管穿孔是自发性的。尽管有现代治疗方法，死亡率仍然很高。既往肺部疾病、肝脏疾病以及与恶性肿瘤相关的穿孔与医院死亡率显著相关。在部分患者中，挽救性食管切除术取得了成功。
