Eroglu Atilla, Aydin Yener, Ulas Ali Bilal
Department of Thoracic Surgery, Atatürk University School of Medicine, Erzurum, Turkey.
Eurasian J Med. 2022 Feb;54(1):100-105. doi: 10.5152/eurasianjmed.2022.21135.
Although esophageal perforation is rare, it is a life-threatening condition. The esophagus is very sensitive to rupture and perforation due to the absence of a serosal layer. More than half of the esophageal perforations are iatrogenic and most occur during endoscopy. Around 55% of esophageal injuries occur in the intrathoracic region, 25% in the cervical region, and 20% in the abdominal region. Clinical manifestations and mortality are related to various components such as the etiology, localization, type of injury, severity of contamination, injury to adjacent mediastinal structures, and time from perforation to treatment. When perforation occurs in the esophagus, saliva, stomach contents, bile fluid, and other secretions may pass into the mediastinum causing mediastinal emphysema, inflammation followed by mediastinal necrosis, and chemical mediastinitis. Early clinical suspicion and imaging are essential for successful treatment. Despite advances in technology and treatment, the morbidity and mortality rate due to esophageal perforation is still higher than 20% according to the reported studies. Until now, the main treatment of esophageal perforation was the surgical approach. Nowadays, endoluminal procedures such as endoscopic vacuum therapy, endoscopic stent placement, endoscopic clip closure, endoscopic suturing, and tissue adhesives have started to be applied more. In this review, the minimally invasive and endoscopic approach methods suitable for esophageal perforation according to the characteristics of the patients and the structure of the perforation were examined.
尽管食管穿孔很少见，但它是一种危及生命的疾病。由于缺乏浆膜层，食管对破裂和穿孔非常敏感。超过一半的食管穿孔是医源性的，大多数发生在内镜检查期间。约55%的食管损伤发生在胸段，25%发生在颈段，20%发生在腹段。临床表现和死亡率与多种因素有关，如病因、部位、损伤类型、污染严重程度、相邻纵隔结构损伤以及从穿孔到治疗的时间。当食管发生穿孔时，唾液、胃内容物、胆汁液和其他分泌物可能进入纵隔，导致纵隔气肿、炎症继而纵隔坏死以及化学性纵隔炎。早期临床怀疑和影像学检查对于成功治疗至关重要。尽管技术和治疗取得了进展，但根据报道的研究，食管穿孔导致的发病率和死亡率仍高于20%。到目前为止，食管穿孔的主要治疗方法是手术。如今，内镜下真空治疗、内镜支架置入、内镜夹闭、内镜缝合和组织粘合剂等腔内手术已开始得到更多应用。在本综述中，根据患者的特点和穿孔的结构，研究了适用于食管穿孔的微创和内镜治疗方法。
