Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
Department of Orthopedic Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
Acta Otorhinolaryngol Ital. 2024 Aug;44(4):214-222. doi: 10.14639/0392-100X-N2905.
The study aimed to identify factors affecting the management and prognosis of iatrogenic cervical oesophageal and hypopharyngeal perforations (iCEHPs).
We retrospectively analysed 24 patients treated for iCEHP between 2004 and 2021 at a tertiary university medical centre. Data on demographics, clinical features, imaging, management and outcomes were collected. Factors associated with primary management and patient outcome were assessed.
The most common management approach was surgical neck exploration (15 patients, 62.5%). Surgical management was used in 93% of uncontained perforations compared to 11% of contained perforations (p < 0.001). Surgically-treated patients had higher levels of C-reactive protein (CRP) than conservatively-treated patients (median, 18.3 4.8 mg/dL; p = 0.001). Delayed diagnosis (≥ 24 hours) was associated with increased mortality (100 5%; p = 0.011). The mortality rate was significantly higher in patients who had a history of neck irradiation than in patients who did not (67 5%; p = 0.032).
Early diagnosis of iCEHP improves outcomes. The appropriate management should be carefully selected on the basis of CRP level and imaging findings. Prior neck radiation is a poor prognostic factor.
本研究旨在确定影响医源性颈食管和下咽穿孔（iCEHPs）管理和预后的因素。
我们回顾性分析了 2004 年至 2021 年在一家三级大学医学中心治疗的 24 例 iCEHP 患者。收集了人口统计学、临床特征、影像学、管理和结果的数据。评估了与主要管理和患者结局相关的因素。
最常见的管理方法是手术颈探查（15 例，62.5%）。与 11%的封闭性穿孔相比，93%的未封闭性穿孔采用手术治疗（p < 0.001）。手术治疗患者的 C 反应蛋白（CRP）水平高于保守治疗患者（中位数，18.3 ± 4.8 mg/dL；p = 0.001）。延迟诊断（≥24 小时）与死亡率增加相关（100% 5%；p = 0.011）。有颈部放疗史的患者死亡率明显高于无颈部放疗史的患者（67% 5%；p = 0.032）。
早期诊断 iCEHP 可改善预后。应根据 CRP 水平和影像学发现仔细选择适当的治疗方法。既往颈部放疗是预后不良的一个因素。
