Bisgaard T, Wøjdemann M, Heindorff H, Svendsen L B
Dept. of Surgical Gastroenterology, Rigshospitalet, National University Hospital, Copenhagen, Denmark.
Endoscopy. 1997 Mar;29(3):155-9. doi: 10.1055/s-2007-1004155.
Iatrogenic esophageal perforation during palliative endoscopic treatment in patients with incurable esophageal or cardiac cancer is a severe complication, associated with a high rate of mortality. The treatment remains controversial, since both nonsurgical and surgical treatment regimens are used. The present study describes a nonsurgical regimen.
Nine cases of perforation occurred in 142 consecutive patients referred for endoscopic palliation of dysphagia, corresponding to a perforation rate of 6%. Laser therapy was the main treatment used (argon plasma coagulation or Nd:YAG photocoagulation).
Nonsurgical treatment was successful in six patients (75%). Two patients died (22%) as a direct result of esophageal perforation following endoscopic palliation procedures.
These findings show an acceptable mortality rate using a nonsurgical treatment regimen involving broad-spectrum antibiotics, nasogastric suction, and parenteral nutrition, with pleural drainage and endoprosthesis placement in addition when indicated.
在无法治愈的食管癌或贲门癌患者的姑息性内镜治疗过程中，医源性食管穿孔是一种严重并发症，死亡率很高。由于非手术和手术治疗方案均有使用，治疗方法仍存在争议。本研究描述了一种非手术方案。
142例因吞咽困难接受内镜姑息治疗的连续患者中发生了9例穿孔，穿孔率为6%。激光治疗是主要的治疗方法（氩离子凝固术或钕：钇铝石榴石激光光凝术）。
6例患者（75%）非手术治疗成功。2例患者（22%）在内镜姑息治疗后因食管穿孔直接死亡。
这些结果表明，使用包括广谱抗生素、鼻胃管抽吸和肠外营养在内的非手术治疗方案，在必要时辅以胸腔引流和放置内支架，死亡率是可以接受的。
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