Platel J P, Thomas P, Giudicelli R, Lecuyer J, Giacoia A, Fuentes P
Service de Chirurgie Thoracique et des Maladies de l'Oesophage, Hôpital Sainte-Marguerite, Marseille.
Ann Chir. 1997;51(6):611-6.
To identify the determinants and results on conservative management of oesophageal perforations and ruptures.
Retrospective clinical review of 34 consecutive patients (mean age: 62 years) treated for cervical (n = 10) or thoracic (n = 24) oesophageal disruption between 1985 and 1996. Causes were: spontaneous rupture (n = 10), instrumental perforation (n = 16), alimentary foreign body (n = 6), and blunt (n = 1) or penetrating trauma (n = 1). The diagnostic delay exceeded 24 hours in 15 cases.
A nonoperative management was achieved in 8 patients with no mortality. A conservative surgical treatment was attempted in 23 patients, primary repair in 21 and open drainage in 2, with a 17.4% mortality. Resection (n = 2) or exclusion (n = 1) was performed in 3 patients with no early mortality, but one of them died as result of the subsequent reconstructive operation to restore oesophageal continuity. Overall morbidity was linked to the spontaneous cause of the perforation. Outcome of patients undergoing primary repair was not influenced by the diagnostic delay nor the surrounding sepsis.
Conservative management should be advocated for the treatment of oesophageal perforations and ruptures, even in case of delayed diagnostiqiagnosis, regardless of the surrounding sepsis and cause of disruption.
确定食管穿孔和破裂保守治疗的决定因素及结果。
对1985年至1996年间连续治疗的34例（平均年龄：62岁）颈段（n = 10）或胸段（n = 24）食管破裂患者进行回顾性临床研究。病因包括：自发性破裂（n = 10）、器械穿孔（n = 16）、消化道异物（n = 6）、钝性（n = 1）或穿透性创伤（n = 1）。15例患者诊断延迟超过24小时。
8例患者采用非手术治疗，无死亡病例。23例患者尝试进行保守手术治疗，21例进行一期修复，2例进行开放引流，死亡率为17.4%。3例患者进行了切除（n = 2）或旷置（n = 1），早期无死亡病例，但其中1例在随后恢复食管连续性的重建手术中死亡。总体发病率与穿孔的自发性病因有关。一期修复患者的预后不受诊断延迟或周围感染的影响。
即使在诊断延迟的情况下，无论周围是否存在感染及破裂原因，食管穿孔和破裂的治疗都应提倡保守治疗。
