Napolitano Antonio Giulio, Nachira Dania, Petracca Ciavarella Leonardo, Coviello Eleonora, Pourmolkara Domenico, Vaz Sousa Rita, Meacci Elisa, De Giacomo Tiziano, Venuta Federico, Porziella Venanzio, Margaritora Stefano, Puma Francesco, Vannucci Jacopo
Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, 00136 Rome, Italy.
Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06129 Perugia, Italy.
J Clin Med. 2025 Jun 6;14(12):4019. doi: 10.3390/jcm14124019.
Oesophageal perforation (OP) is a life-threatening condition requiring prompt diagnosis and treatment. Mortality is influenced by several factors, such as aetiology, defect location, comorbidities, age, and delays in treatment. This study reviews patients with OP undergoing surgery, analysing mortality risks and the impact of timing on surgical outcomes. Medical records of 45 patients surgically treated for OP across three tertiary centers were analysed. Of the 45 patients, 31 were male (68.88%) and 14 were female (31.11%), with a mean age of 66.00 ± 17.75 years. Pre-operative CT was performed in all patients, and 18 (40%) underwent oesophagogastroduodenoscopy. As many as 25 patients (55.55%) presented within 24 h, 10 (22.22%) within 24-72 h, and 10 (22.22%) after 72 h. Symptoms included pain, vomiting, fever, dysphagia, and subcutaneous emphysema. Foreign body ingestion and Boerhaave's syndrome were the leading causes (33.33% each), followed by caustic ingestion (17.77%) and iatrogenic and traumatic cases. Treatments included primary repair, debridement, oesophagectomy, and oesophagogastrectomy. Primary repair was performed in 22 cases (48.88%), and muscle flaps reinforced 11 of these. Direct repair showed the highest success rate when performed within 24 h. Thirty patients (66.66%) experienced complications, including respiratory failure, oesophagopleural fistula, and sub-stenosis. The hospital stay average was 36.34 ± 35.03 days. Nine patients underwent same-session/two-stage gastroplasty or retrosternal coloplasty for reconstruction, with complications including stenosis and leaks. Six patients (13.33%) died within the first 24 h after surgery, primarily due to severe comorbidities (three (50%) were octogenarians). OP is a life-threatening condition with high mortality. Primary repair is the preferred treatment. Oesophagectomy and gastrectomy are reserved for extensive lesions. Muscle flaps can reinforce sutures in cervical and thoracic perforations. Mortality is mainly influenced by the severity of the patient's clinical picture and comorbidities, rather than by time and type of treatment.
食管穿孔（OP）是一种危及生命的疾病，需要迅速诊断和治疗。死亡率受多种因素影响，如病因、缺损部位、合并症、年龄和治疗延迟等。本研究回顾了接受手术治疗的OP患者，分析死亡风险以及手术时机对手术结果的影响。分析了三个三级中心接受手术治疗的45例OP患者的病历。45例患者中，男性31例（68.88%），女性14例（31.11%），平均年龄66.00±17.75岁。所有患者均进行了术前CT检查，18例（40%）接受了食管胃十二指肠镜检查。多达25例患者（55.55%）在24小时内就诊，10例（22.22%）在24至72小时内就诊，10例（22.22%）在72小时后就诊。症状包括疼痛、呕吐、发热、吞咽困难和皮下气肿。异物摄入和博雷哈夫综合征是主要原因（各占33.33%），其次是腐蚀性物质摄入（17.77%）以及医源性和创伤性病例。治疗方法包括一期修复、清创、食管切除术和食管胃切除术。22例（48.88%）患者进行了一期修复，其中11例采用肌瓣加强。在24小时内进行直接修复成功率最高。30例患者（66.66%）出现并发症，包括呼吸衰竭、食管胸膜瘘和狭窄。平均住院时间为36.34±35.03天。9例患者接受了同期/两阶段胃成形术或胸骨后结肠成形术进行重建，并发症包括狭窄和渗漏。6例患者（13.33%）在术后24小时内死亡，主要原因是严重合并症（3例（50%）为八旬老人）。OP是一种死亡率高的危及生命的疾病。一期修复是首选治疗方法。食管切除术和胃切除术用于广泛病变。肌瓣可加强颈部和胸部穿孔的缝合。死亡率主要受患者临床表现和合并症严重程度的影响，而非治疗时间和类型。
