Segalin A, Bonavina L, Lazzerini M, De Ruberto F, Faranda C, Peracchia A
Department of General and Oncologic Surgery, University of Milan, Italy.
Surg Endosc. 1996 Sep;10(9):928-32. doi: 10.1007/BF00188486.
The endoscopic management of four selected patients with inveterate esophageal perforations or leaks is presented. One patient had a perforation of the cervical esophagus following endoscopic removal of a foreign body already treated with surgical drainage; two patients had a leak following diverticulectomy and esophagogastrostomy, respectively, persistent after multiple surgical repairs; the last patient had a spontaneous perforation of the thoracic esophagus persistent after two transthoracic repairs. The mean time elapsed between the diagnosis of perforation and the endoscopic treatment was 19 days. In one patient, transesophageal drainage of a mediastinal abscess was performed. In the other three patients, a stent was placed to seal the leak in combination with gastric and esophageal aspiration. Two of these patients underwent endoscopy in critical condition and could have not been candidates for major surgical procedures. All patients received enteral nutrition. No morbidity or mortality related to the endoscopic procedure was recorded; the treatment was effective in all patients who recovered and resumed oral feeding within 3 weeks. We conclude that endoscopic transesophageal drainage and stenting are effective procedures in the management of patients with inveterate esophageal perforations or leaks.
本文介绍了对4例顽固性食管穿孔或渗漏患者的内镜治疗情况。1例患者在经手术引流治疗后内镜下取出异物时发生颈段食管穿孔；2例患者分别在憩室切除和食管胃造口术后发生渗漏，经多次手术修复后仍持续存在；最后1例患者在两次开胸修复后胸段食管仍发生自发性穿孔。穿孔诊断至内镜治疗的平均间隔时间为19天。1例患者进行了经食管纵隔脓肿引流。另外3例患者放置了支架以封闭渗漏，并结合胃和食管吸引。其中2例患者在病情危急时接受了内镜检查，不适合进行大型外科手术。所有患者均接受肠内营养。未记录到与内镜操作相关的 morbidity 或死亡率；治疗对所有在3周内康复并恢复经口进食的患者均有效。我们得出结论，内镜经食管引流和支架置入是治疗顽固性食管穿孔或渗漏患者的有效方法。
