Jeong Eui Sun, Jung Hye-Kyung, Byeon Ju Ran, Lee Ayoung, Hong Ji Taek, Kim Seong-Eun, Moon Chang Mo
Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
Korean J Helicobacter Up Gastrointest Res. 2023 Mar;23(1):42-51. doi: 10.7704/kjhugr.2022.0057. Epub 2023 Feb 1.
BACKGROUND/AIMS: Esophageal perforation is associated with high mortality and morbidity in patients presenting to the emergency department (ED) with esophageal injury. We investigated the effectiveness of initial CT scan in patients with esophageal injury to determine the risk factors for complications.
Patients admitted through the ED for evaluation of esophageal injuries between January 2001 and May 2020, were investigated. Demographic data, etiological factors, comorbidities, treatment administered, and outcomes were collected. Esophageal injury was graded based on the following CT criteria: (a) normal, (b) pneumomediastinum, (c) mediastinitis, fluid collection, abscess, or overt esophageal wall injury, and (d) pleural effusion, subcutaneous emphysema, or pneumothorax. Grade 2 was defined as microperforation and grades 3 and 4 as overt perforation.
Of 281 patients with esophageal injury, 38 had CT-documented overt perforations and 20 had microperforations. Foreign body-induced injury (n=37), Boerhaave syndrome (n=12), and chemical injury (n=3) were common causes of esophageal injury. Complications occurred in 24 (8.5%) patients. Risk factors for complications were age ≥65 years (OR 4.14, 95% CI 1.1814.56, =0.027), cerebrovascular disease (OR 8.58, 95% CI 1.1365.19, =0.038), Boerhaave syndrome (OR 12.52, 95% CI 2.0775.68, =0.006), chemical injury (OR 15.72, 95% CI 3.6767.28, <0.001), and CT-documented grade 4 perforation (OR 15.75, 95% CI 4.39~56.55, <0.001).
Initial CT-based grading in the ED are useful for predicting potential complications and for managing patients with esophageal injury and suspected perforation.
背景/目的：在因食管损伤就诊于急诊科（ED）的患者中，食管穿孔与高死亡率和高发病率相关。我们研究了初始CT扫描对食管损伤患者的有效性，以确定并发症的危险因素。
对2001年1月至2020年5月期间通过急诊科收治以评估食管损伤的患者进行研究。收集人口统计学数据、病因、合并症、所给予的治疗及结局。根据以下CT标准对食管损伤进行分级：（a）正常；（b）纵隔气肿；（c）纵隔炎、液体积聚、脓肿或明显的食管壁损伤；（d）胸腔积液、皮下气肿或气胸。2级定义为微穿孔，3级和4级为明显穿孔。
在281例食管损伤患者中，38例有CT记录的明显穿孔，20例有微穿孔。异物所致损伤（n = 37）、博雷尔综合征（n = 12）和化学损伤（n = 3）是食管损伤的常见原因。24例（8.5%）患者发生并发症。并发症的危险因素为年龄≥65岁（比值比4.14，95%置信区间1.1814.56，P = 0.（此处原文有误，推测应为0.027））、脑血管疾病（比值比8.58，95%置信区间1.1365.19，P = 0.038）、博雷尔综合征（比值比12.52，95%置信区间2.0775.68，P = 0.006）、化学损伤（比值比15.72，95%置信区间3.6767.28，P<0.001）以及CT记录的4级穿孔（比值比15.75，95%置信区间4.39~56.55，P<0.001）。
急诊科基于CT的初始分级有助于预测潜在并发症，并有助于管理食管损伤和疑似穿孔的患者。
