Richardson J D, Martin L F, Borzotta A P, Polk H C
Am J Surg. 1985 Jan;149(1):157-62. doi: 10.1016/s0002-9610(85)80026-x.
We treated 75 patients with esophageal trauma, perforation, or anastomotic leak. Several factors were shown to be associated with an increased mortality, including delayed treatment, presence of severe underlying esophageal disease, total parenteral nutrition catheter infection, the necessity for major extirpative procedures to treat the perforation, and the use of exclusion and diversion in the continuity procedure. The use of local muscle flaps to buttress suture line closure has led to excellent results in the 19 patients so treated. Delayed treatment of perforation or an anastomotic leak is a major problem, but the treatment protocol described herein has led to the survival of 12 of 16 patients treated. The use of primary muscle flap closure for extensive esophageal defects or delayed treatment of nonhealing leaks was evaluated in five patients. All five had healing of the defect, with one resultant esophageal stricture.
我们治疗了75例食管创伤、穿孔或吻合口漏患者。有几个因素与死亡率增加相关，包括治疗延迟、存在严重的潜在食管疾病、全胃肠外营养导管感染、治疗穿孔需要进行大型切除手术，以及在连续性手术中采用旷置和转流术。对19例采用局部肌瓣支撑缝合线闭合术治疗的患者取得了良好效果。穿孔或吻合口漏的延迟治疗是一个主要问题，但本文所述的治疗方案使16例接受治疗的患者中有12例存活。对5例患者评估了使用原发性肌瓣闭合术治疗广泛性食管缺损或延迟治疗不愈合漏的情况。所有5例患者的缺损均愈合，其中1例出现食管狭窄。
