Sarr M G, Pemberton J H, Payne W S
J Thorac Cardiovasc Surg. 1982 Aug;84(2):211-8.
Experience with 47 consecutive instrumental perforations of the esophagus is described. Perforation occurred in the cervical esophagus in 18 patients, mid-thoracic esophagus in 12, and distal esophagus in 17. The majority of patients (87%) harbored a primary esophageal disorder necessitating esophageal instrumentation. Eight select patients were treated nonoperatively with one death; however, some form of morbidity with prolonged hospital stay occurred in half of these patients. In contrast, 39 patients underwent emergency surgical intervention. Only one death occurred in the 31 patients treated by local drainage and attempted closure of the perforation. However, three of six patients with distal perforations treated by esophageal resection with primary esophagogastrostomy died in the early postoperative period. Our results suggest that most instrumental perforations of the esophagus should be managed surgically. Drainage and closure of cervical perforations yields goods results. Esophageal resection with primary reconstitution of esophagogastric continuity should be reserved for select situations. Nonoperative management might be entertained in minimally symptomatic patients harboring a late, locally contained perforation without signs of ongoing sepsis.
本文描述了连续47例食管器械穿孔的经验。穿孔发生在18例患者的颈段食管、12例患者的胸段中段食管和17例患者的食管远端。大多数患者（87%）患有需要进行食管器械操作的原发性食管疾病。8例经选择的患者接受了非手术治疗，其中1例死亡；然而，这些患者中有一半出现了某种形式的并发症并延长了住院时间。相比之下，39例患者接受了急诊手术干预。在31例接受局部引流和穿孔修补术的患者中仅1例死亡。然而，6例接受食管切除并一期食管胃吻合术治疗的远端穿孔患者中有3例在术后早期死亡。我们的结果表明，大多数食管器械穿孔应采用手术治疗。颈段穿孔的引流和闭合效果良好。食管切除并一期重建食管胃连续性应仅用于特定情况。对于症状轻微、穿孔时间较晚且局限于局部、无持续脓毒症迹象的患者，可考虑非手术治疗。
