Magradze Givi, Knopf Andreas, Becker Christoph, Ketterer Manuel Christoph
Department of Otorhinolaryngology, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Centre Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.
Eur Arch Otorhinolaryngol. 2025 May;282(5):2549-2555. doi: 10.1007/s00405-024-09115-9. Epub 2024 Dec 4.
The primary aim of this study is to evaluate the impact of diagnostic procedures and treatment interventions performed at our medical institution on the final outcomes and survival rates of patients with iatrogenic and traumatic pharyngeal perforation (PP).
We reviewed the medical records of 36 patients with iatrogenic and trauma-induced PP who were treated at the Quaternary Medical Center of Otorhinolaryngology between 2010 and 2020. Comorbidities were classified according to the Age-adjusted Charlson Comorbidity Index (ACCI) scoring system, and postoperative complications were classified according to the Clavien and Dindo scoring system.
Of the 36 patients, 15 (41.7%) were male and 21 (58.3%) were female. The median age was 73 years, and PP was typically diagnosed within one day. Notably, the perforation site was identified in the hypopharynx in 29 (80.5%) patients. The median ACCI score was 4, with the most frequent ACCI score observed being 5. During the treatment course, 17 patients (47.2%) experienced complications, with 9 of these patients experiencing grade IV complications according to the Clavien and Dindo classification.
Our study showed that patients with hypopharyngeal perforations have an almost 42-fold higher risk of mortality during hospitalization compared to those with epipharyngeal or oropharyngeal perforations, though results are limited by the small sample size and the variable dates. Additionally, neurosurgery of the cervical spine, transesophageal echocardiography, and diverticular surgery emerged as procedures carrying the highest risk for pharyngeal perforations. Within our patient cohort, 4 patients (11.11%, all female) died during the treatment course.
本研究的主要目的是评估在我们医疗机构进行的诊断程序和治疗干预对医源性和创伤性咽穿孔（PP）患者最终结局和生存率的影响。
我们回顾了2010年至2020年在耳鼻喉科四级医疗中心接受治疗的36例医源性和创伤性PP患者的病历。根据年龄调整的查尔森合并症指数（ACCI）评分系统对合并症进行分类，根据Clavien和Dindo评分系统对术后并发症进行分类。
36例患者中，15例（41.7%）为男性，21例（58.3%）为女性。中位年龄为73岁，PP通常在一天内确诊。值得注意的是，29例（80.5%）患者的穿孔部位位于下咽。ACCI评分中位数为4，最常见的ACCI评分为5。在治疗过程中，17例患者（47.2%）出现并发症，其中9例根据Clavien和Dindo分类为IV级并发症。
我们的研究表明，下咽穿孔患者住院期间的死亡风险比咽上壁或口咽穿孔患者高近42倍，尽管结果受到样本量小和日期可变的限制。此外，颈椎神经外科手术、经食管超声心动图检查和憩室手术是发生咽穿孔风险最高的手术。在我们的患者队列中，4例患者（11.11%，均为女性）在治疗过程中死亡。
