Pan Jiajian, Ge Yong, Feng Tianci, Zheng Chengwen, Zhang Xueqiu, Feng Shoujie, Sun Teng, Zhao Feng, Sha Zhengbu, Zhang Hao
Thoracic Surgery Laboratory, Xuzhou Medical University.
Department of Thoracic Surgery, The Affiliated Hospital of Xuzhou Medical University.
Int J Surg. 2025 Jan 1;111(1):1135-1143. doi: 10.1097/JS9.0000000000001853.
Current treatment modalities for spontaneous esophageal perforation remain controversial because of their rarity.
To describe our institution's experience in managing patients with spontaneous esophageal rupture and conduct a meta-analysis of existing studies to determine the best evidence-based treatment options.
The authors enrolled patients with spontaneous esophageal rupture who underwent their first treatment at our institution. The authors also identified studies through a systematic search of the MEDLINE, EMBASE, and Cochrane Library databases before 1 April 2024, for inclusion in the meta-analysis.
This case series included data from 17 patients with delayed diagnosis who were treated with esophageal stents, with an immediate mortality rate of 5.9%. In addition to the cases from our institution, the authors obtained 944 patients from 46 studies in the final analysis. The combined immediate mortality rate was 11% (95% CI: 0.08-0.15). The combined reintervention rate was 11% (95% CI: 0.05-0.19). The combined immediate mortality was 6% (95% CI: 0.04-0.09) after primary closure, 14% (95% CI: 0.02-0.32) after T-tube drain repair, 2% (95% CI: 0.00-0.15) after esophagectomy, 8% (95% CI: 0.03-0.15) after stent placement, and 22% (95% CI: 0.03-0.47) after conservative treatment. The subgroup analysis based on the timing of the intervention showed that the immediate mortality rate in patients initiating treatment within 24 h of rupture was 3% (95% CI: 0.01-0.08), whereas that in patients initiating treatment >24 h later was 12% (95% CI: 0.08-0.18).
Outcomes are best after esophagectomy, and primary closure or esophageal stenting is a good option compared with other treatment modalities. Prognosis is related to the timing of intervention, and accurate diagnosis and treatment within 24 h significantly reduces the risk of death in patients. Patients with delayed diagnosis may have a better prognosis with stent placement.
由于自发性食管穿孔较为罕见，目前其治疗方式仍存在争议。
描述我院在治疗自发性食管破裂患者方面的经验，并对现有研究进行荟萃分析，以确定基于最佳证据的治疗方案。
作者纳入了在我院接受首次治疗的自发性食管破裂患者。作者还通过系统检索2024年4月1日前的MEDLINE、EMBASE和Cochrane图书馆数据库来确定研究，以纳入荟萃分析。
该病例系列纳入了17例延迟诊断且接受食管支架治疗的患者数据，其即刻死亡率为5.9%。除了我院的病例外，作者在最终分析中还从46项研究中获取了944例患者的数据。综合即刻死亡率为11%（95%CI：0.08 - 0.15）。综合再次干预率为11%（95%CI：0.05 - 0.19）。一期缝合后综合即刻死亡率为6%（95%CI：0.04 - 0.09），T管引流修复后为14%（95%CI：0.02 - 0.32），食管切除术后为2%（95%CI：0.00 - 0.15），支架置入后为8%（95%CI：0.03 - 0.15），保守治疗后为22%（95%CI：0.03 - 0.47）。基于干预时机的亚组分析显示，破裂后24小时内开始治疗的患者即刻死亡率为3%（95%CI：0.01 - 0.08），而24小时后开始治疗的患者即刻死亡率为12%（95%CI：0.08 - 0.18）。
食管切除术后预后最佳，与其他治疗方式相比，一期缝合或食管支架置入是较好的选择。预后与干预时机有关，24小时内准确诊断和治疗可显著降低患者死亡风险。延迟诊断的患者支架置入可能预后较好。
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