Department of General Surgery, St Mary's Hospital, Isle of Wight, Newport, United Kingdom.
Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom.
J Laparoendosc Adv Surg Tech A. 2021 Nov;31(11):1254-1261. doi: 10.1089/lap.2020.0751. Epub 2021 Jan 5.
Boerhaave's syndrome is a life-threatening spontaneous perforation of the esophagus associated with significant morbidity and mortality. Historically, thoracotomy has been the mainstay of treatment, but is associated with high morbidity and pain. Minimally invasive approaches provide alternative treatment possibilities. This systematic review together with inclusion of a case series from a tertiary esophagogastric unit assesses current evidence focused on minimally invasive surgical management of this condition. A systematic review was conducted in line with MOOSE (Meta-analyses Of Observational Studies in Epidemiology) guidelines. Electronic databases PubMed, MEDLINE, and Cochrane Library were searched, and articles focusing on the minimally invasive management of Boerhaave's syndrome were identified and scrutinized. We also report demographics and outcomes for a consecutive case series of patients with acute Boerhaave's syndrome managed via thoracoscopy. Fifteen studies were included comprising 5 retrospective cohort studies and 10 case reports. Management strategies were divided into three categories: thoracoscopic, endoscopic, and laparoscopic. Overall mortality rates for each treatment modality were 2%, 13%, and 33%, and treatment success rates 98%, 38%, and 67%, respectively. Postoperative infective complications were seen in 79% of patients, with only 2 patients requiring salvage thoracotomy. In our local case series, we report 4 consecutive patients managed with thoracoscopy, with a 100% treatment success rate. Minimally invasive approaches in the management of Boerhaave's syndrome are safe and effective. We propose a selective management algorithm involving a minimally invasive approach to management of this life-threatening condition. Registered with local clinical outcomes team as service evaluation. (Approval number sev/0171).
布氏综合征是一种危及生命的自发性食管穿孔，与显著的发病率和死亡率相关。历史上，开胸手术一直是主要的治疗方法，但与高发病率和疼痛相关。微创方法提供了替代的治疗可能性。本系统评价结合一家三级食管胃单位的病例系列纳入，评估了目前关于微创治疗这种疾病的证据。 根据 MOOSE（观察性研究的荟萃分析流行病学）指南进行了系统评价。电子数据库 PubMed、MEDLINE 和 Cochrane Library 进行了搜索，确定并仔细研究了关注微创管理布氏综合征的文章。我们还报告了通过胸腔镜治疗急性布氏综合征的连续病例系列患者的人口统计学和结果。 包括 5 项回顾性队列研究和 10 项病例报告在内的 15 项研究被纳入。管理策略分为三类：胸腔镜、内镜和腹腔镜。每种治疗方法的总体死亡率分别为 2%、13%和 33%，治疗成功率分别为 98%、38%和 67%。术后感染性并发症见于 79%的患者，仅 2 例患者需要挽救性开胸手术。在我们的本地病例系列中，我们报告了 4 例连续患者通过胸腔镜治疗，治疗成功率为 100%。 微创方法在布氏综合征的治疗中是安全有效的。我们提出了一种选择性管理算法，涉及对这种危及生命的疾病进行微创管理。作为服务评估向当地临床结果团队注册。（批准编号 sev/0171）。
