Nesbitt J C, Sawyers J L
Am Surg. 1987 Apr;53(4):183-91.
The recognition and management of esophageal perforation remain a problem. Diagnostic and treatment delays are common, and controversy continues regarding approaches to surgical intervention. Overall survival has increased with improved adjunctive modalities; however, morbidity and mortality remain high. A total of 115 consecutive cases of nonmalignant esophageal perforation were reviewed. There were 69 thoracic, 27 cervical, and 19 abdominal perforations. Etiology of the perforations was iatrogenic in 65 patients, traumatic in 28, and spontaneous perforation in 22. Symptoms included pain (71%), fever (51%), dyspnea (24%), and crepitus (22%). Contrast roentgenography was used in 78 patients and demonstrated the perforation in all but two patients. All but 20 patients had operations. In the last decade, the survival rate was 11.4 per cent for patients treated within 24 hours of perforation. Survival significantly improved in the last 10 years because of hyperalimentation, cardiopulmonary monitoring, and better antibiotic coverage. Treatment of choice is primary closure with drainage, regardless of the duration of the perforation. In selected patients who have cervical esophageal perforation, nonoperative management has a role.
食管穿孔的识别与处理仍是一个难题。诊断和治疗延误很常见，关于手术干预的方法也一直存在争议。随着辅助治疗手段的改进，总体生存率有所提高；然而，发病率和死亡率仍然很高。回顾了连续115例非恶性食管穿孔病例。其中69例为胸段穿孔，27例为颈段穿孔，19例为腹段穿孔。穿孔的病因在65例患者中为医源性，28例为外伤性，22例为自发性穿孔。症状包括疼痛（71%）、发热（51%）、呼吸困难（24%）和皮下气肿（22%）。78例患者采用了造影剂X线检查，除2例患者外均显示有穿孔。除20例患者外，其余均接受了手术。在过去十年中，穿孔后24小时内接受治疗的患者生存率为11.4%。由于肠外营养、心肺监测和更好的抗生素覆盖，过去10年生存率显著提高。无论穿孔时间长短，首选的治疗方法是一期缝合加引流。对于某些颈段食管穿孔患者，非手术治疗也有一定作用。
