Mizutani K, Makuuchi H, Tajima T, Mitomi T
Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan.
Surg Today. 1997;27(9):793-800. doi: 10.1007/BF02385268.
Esophageal perforations are extremely difficult to diagnose and treat. We report herein our results of a review of 26 patients with esophageal perforation which were spontaneous in 11, iatrogenic in 11, and caused by a foreign body in 4. Surgical treatment was performed in 7 of the patients with spontaneous rupture, but the remaining 19 patients were treated conservatively. The abnormality was found by plain radiography (X-ray) in 22 (85%) of the 26 patients, and by computed tomography (CT) in all 13 patients who underwent this procedure. The detection rates by esophagography and esophagoscopy were 100%, or all of 25 patients examined, and 60%, or 9 of 15 patients examined, respectively. Of 12 patients with underlying diseases, 4 (33%) died after the perforation, whereas only 1 (7%) of 14 patients without any underlying disease died. Postoperative empyema developed in all of 3 patients treated by intraoperative unfixed intrathoracic drainage (UID), but in none of the 4 treated by fixed intrathoracic drainage (FID). Conservative treatment achieved satisfactory results for spontaneous esophageal ruptures confined to the mediastinum, and for iatrogenic perforations and esophageal perforations caused by foreign bodies, provided there was no serious underlying disease such as advanced cirrhosis. Moreover, intraoperative FID proved useful in helping to prevent postoperative empyema.
食管穿孔极难诊断和治疗。我们在此报告对26例食管穿孔患者的回顾性研究结果，其中11例为自发性穿孔，11例为医源性穿孔，4例由异物导致。11例自发性穿孔患者中有7例接受了手术治疗，其余19例患者接受了保守治疗。26例患者中有22例（85%）通过X线平片发现异常，13例接受计算机断层扫描（CT）检查的患者均通过CT发现异常。食管造影和食管镜检查的检出率分别为100%（25例接受检查的患者全部检出）和60%（15例接受检查的患者中有9例检出）。12例有基础疾病的患者中，4例（33%）在穿孔后死亡，而14例无基础疾病的患者中只有1例（7%）死亡。3例术中采用不固定胸腔内引流（UID）治疗的患者均发生了术后脓胸，而4例采用固定胸腔内引流（FID）治疗的患者均未发生。对于局限于纵隔的自发性食管破裂、医源性穿孔和异物导致的食管穿孔，若不存在晚期肝硬化等严重基础疾病，保守治疗可取得满意效果。此外，术中FID被证明有助于预防术后脓胸。
