Bufkin B L, Miller J I, Mansour K A
Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Ann Thorac Surg. 1996 May;61(5):1447-51; discussion 1451-2. doi: 10.1016/0003-4975(96)00053-7.
Perforation of the esophagus is a deadly injury that requires expert management for survival.
We performed a retrospective clinical review of 66 patients treated at Emory University affiliated hospitals for esophageal perforation between 1973 and 1993.
Iatrogenic perforations accounted for 48 injuries (73%), barogenic perforations occurred in 12 patients (17%), trauma was causative in 3 (5%), and 3 patients had esophageal infection and other causes. Lower-third injuries occurred in 43 cases (65%), middle third in 14 (21%), and upper third in 9 (14%). Early contained perforations were managed successfully by limiting oral intake and giving parenteral antibiotics in 12 patients. Cervical perforations were drained without attempt at closure of the leak. Perforations with mediastinal or pleural contamination recognized early were managed by primary closure and drainage in 28 patients. Reinforcement of the primary closure using stomach fundus, pleural, diaphragmatic, or pericardial flap was performed in 16 patients. Those perforations that escaped early recognition required thoughtful management, using generous debridement and drainage and sometimes esophageal resection. The esophageal T tube provided control of leaks in 3 of these patients and was a useful adjunct. Using these management principles, we achieved a 76% survival rate for all patients. Six patients with perforations complicating endoesophageal management of esophageal varices were a high-risk subset with an 83% mortality rate.
Esophageal perforation remains an important thoracic emergency. Aggressive operative therapy remains the mainstay for treatment; however, conservative management may be preferred for contained perforations and the esophageal T tube may be used for late perforations.
食管穿孔是一种致命性损伤，需要专业处理才能存活。
我们对1973年至1993年间在埃默里大学附属医院接受治疗的66例食管穿孔患者进行了回顾性临床研究。
医源性穿孔48例（73%），气压性穿孔12例（17%），创伤导致3例（5%），3例患者因食管感染及其他原因穿孔。食管下三分之一段穿孔43例（65%），中三分之一段14例（21%），上三分之一段9例（14%）。12例早期局限性穿孔患者通过限制经口进食和给予肠外抗生素成功处理。颈部穿孔未尝试封闭漏口，仅行引流。28例早期发现的伴有纵隔或胸膜污染的穿孔患者行一期缝合和引流。16例患者使用胃底、胸膜、膈肌或心包瓣加固一期缝合。那些未被早期发现的穿孔需要精心处理，包括广泛清创和引流，有时需行食管切除术。食管T管在其中3例患者中控制了漏口，是一种有用的辅助手段。采用这些处理原则，所有患者的生存率为76%。6例因食管静脉曲张行食管内治疗并发穿孔的患者是高危亚组，死亡率为83%。
食管穿孔仍然是一种重要的胸部急症。积极的手术治疗仍然是主要的治疗方法；然而，对于局限性穿孔，保守治疗可能更可取，食管T管可用于晚期穿孔。
