Goldstein L A, Thompson W R
Am J Surg. 1982 Apr;143(4):495-503. doi: 10.1016/0002-9610(82)90202-1.
A review of 44 patients with 50 esophageal perforations from 1966 through 1980 is presented. The age span was 15 months to 94 years and the male to female ratio was 1 to 1. Each case was studied with regard to presentation, etiology, treatment and complications. Twenty-two cases of esophageal perforation followed instrumentation, including 6 secondary to Mosher bag dilatation for achalasia. Of the remainder, seven patients had spontaneous perforation, five had external trauma, five had intraoperative injury, two had caustic ingestion, and one each had foreign body ingestion, Zollinger-Ellison syndrome and an incarcerated paraesophageal hiatal hernia. Management was nonoperative in 12 patients, primary repair and drainage was performed in 23 patients, and 9 patients underwent drainage and diversion. This series plus 824 patients with esophageal perforation accumulated from a review of the literature emphasizes the importance of the influence of different methods of treatment and time lapse between occurrence and therapy. The type of perforation had no significance on this series. As a result of the experience gained from this series, a treatment protocol is proposed for the management of esophageal perforation.
本文回顾了1966年至1980年间44例患者的50例食管穿孔情况。年龄跨度为15个月至94岁，男女比例为1:1。对每例病例的临床表现、病因、治疗及并发症进行了研究。22例食管穿孔发生于器械操作后，其中6例继发于用于贲门失弛缓症的莫舍尔气囊扩张术。其余患者中，7例为自发性穿孔，5例为外部创伤，5例为术中损伤，2例为腐蚀性物质摄入，1例为异物摄入、1例为佐林格-埃利森综合征、1例为嵌顿性食管旁裂孔疝。12例患者采用非手术治疗，23例患者进行了一期修复和引流，9例患者接受了引流和改道手术。本系列病例加上通过文献回顾积累的824例食管穿孔患者强调了不同治疗方法以及穿孔发生与治疗之间时间间隔的影响的重要性。本系列中穿孔类型无显著意义。基于本系列所获得的经验，提出了食管穿孔治疗方案。
