Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Division of Gastro-Intestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Esophagus. 2020 Jul;17(3):230-238. doi: 10.1007/s10388-020-00744-7. Epub 2020 May 15.
To get a clear view of the current state of treatment for esophageal perforation in Japan. Esophagus perforations are the most serious gastrointestinal tract perforations and are associated with high morbidity and mortality. The optimal treatment choice remains unknown.
We conducted a retrospective clinical review of 182 esophageal perforation cases at 108 hospitals accredited by the Japanese Esophageal Society between January 2010 and December 2015.
We found that 20.9% of patients were incorrectly diagnosed initially. We observed mediastinum emphysema in 83.5% of patients, and serious abscess formations of the mediastinum and intrathoracic cavity in 38.6% and 29.6%, respectively. The lower esophagus was the most commonly perforated site (77.7%). Management of esophageal perforations included nonoperative treatment in 20 patients (11%) and operative treatment in 162 patients (89%). The overall mortality rate was 6.9%. The survivors had significantly shorter times from symptom appearance to visit (p = 0.0016), and from time to visit to diagnosis confirmation (p = 0.0011). Moreover, patients older than 65 years, white blood cells less than 3000/mm, C-reactive protein > 10 mg/L, or abscesses in the thoracic cavity showed significantly higher mortality than others.
Shortening the time from onset to the start of treatment contributes to reduce mortality in patients with esophageal perforation. Moreover, strict medical treatment is necessary to lower the mortality rate of elderly patients with strong inflammation and abscesses in the thoracic cavity.
明确日本食管穿孔治疗现状。食管穿孔是最严重的胃肠道穿孔之一，具有较高的发病率和死亡率。目前仍缺乏最佳的治疗选择。
回顾性分析日本食管学会认证的 108 家医院 2010 年 1 月至 2015 年 12 月期间收治的 182 例食管穿孔患者的临床资料。
患者最初误诊率为 20.9%。83.5%的患者出现纵隔气肿，38.6%和 29.6%的患者分别出现严重纵隔和胸腔脓肿形成。下段食管穿孔最为常见（77.7%）。20 例（11%）患者接受非手术治疗，162 例（89%）患者接受手术治疗。总死亡率为 6.9%。幸存者从出现症状到就诊的时间（p=0.0016）和从就诊到确诊的时间（p=0.0011）明显更短。此外，年龄>65 岁、白细胞计数<3000/mm³、C 反应蛋白>10mg/L 或胸腔脓肿患者的死亡率显著更高。
缩短从发病到开始治疗的时间有助于降低食管穿孔患者的死亡率。对于存在强烈炎症和胸腔脓肿的老年患者，严格的内科治疗可能有助于降低死亡率。
