Slim K, Elbaz V, Pezet D, Chipponi J
Service de Chirurgie générale et digestive, Hôtel-Dieu, Clermont-Ferrand.
Presse Med. 1996 Feb 3;25(4):154-6.
Thoracic oesophageal perforations are life-threatening conditions requiring immediate treatment. The type of treatment remains however controversial. The aim of this study was to evaluate the efficacy of the nonoperative management in this disease.
Six patients were admitted in our surgical unit for thoracic oesophageal perforations during the study period. One perforation was spontaneous (Boerhaave's syndrome). One had complicated an oesophageal ulcer. Two were secondary to caustic lesions. Two were secondary to instrumental dilations. The diagnostic and therapeutic delay was < or = 1 day in 5 cases. In one case the delay was 4 days but the mediastinitis was well tolerated. The treatment was based on antibiotics, nasoesophageal tube suction, and total parenteral nutrition.
There was no death in this group of patients. The mediastinitis healed in all cases. In the follow-up period two patients did not have nutritional restriction after healing. Three patients complained of oesophageal stenosis which required oesophageal replacement (n = 2) and dilation (n = 1). One neoplastic stenosis required an endoprosthesis.
Nonoperative treatment is feasible and safe in selected cases of thoracic oesophageal perforations: perforations diagnosed early and confined to the mediastinum, instrumental perforations, and perforations diagnosed late but well tolerated.
胸段食管穿孔是危及生命的疾病，需要立即治疗。然而，治疗方式仍存在争议。本研究的目的是评估非手术治疗在该疾病中的疗效。
在研究期间，6例胸段食管穿孔患者入住我们的外科病房。1例穿孔为自发性（Boerhaave综合征）。1例合并食管溃疡。2例继发于腐蚀性损伤。2例继发于器械扩张。5例患者的诊断和治疗延迟≤1天。1例延迟为4天，但纵隔炎耐受良好。治疗基于抗生素、鼻饲管吸引和全胃肠外营养。
该组患者无死亡病例。所有病例的纵隔炎均愈合。在随访期间，2例患者愈合后无营养限制。3例患者抱怨食管狭窄，其中2例需要食管置换，1例需要扩张。1例肿瘤性狭窄需要置入内支架。
在某些胸段食管穿孔病例中，非手术治疗是可行且安全的：早期诊断且局限于纵隔的穿孔、器械穿孔以及虽诊断较晚但耐受良好的穿孔。
