Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Surgical Treatment of Esophageal Perforation

식도천공의 외과적 치료

  • Park Jae Hong (Department of Thoracic and Cardiovascular Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Chei Chang Seck (Department of Thoracic and Cardiovascular Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim Dae Hwan (Department of Thoracic and Cardiovascular Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Hwang Sang Won (Department of Thoracic and Cardiovascular Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Yoo Byung Ha (Department of Thoracic and Cardiovascular Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim Han Yong (Department of Thoracic and Cardiovascular Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 박재홍 (성균대학교 의과대학 마산삼성병원 흉부외과) ;
  • 최창석 (성균대학교 의과대학 마산삼성병원 흉부외과) ;
  • 김대환 (성균대학교 의과대학 마산삼성병원 흉부외과) ;
  • 황상원 (성균대학교 의과대학 마산삼성병원 흉부외과) ;
  • 유병하 (성균대학교 의과대학 마산삼성병원 흉부외과) ;
  • 김한용 (성균대학교 의과대학 마산삼성병원 흉부외과)
  • Published : 2006.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Perforation of esophagus is relatively uncommon. but it is associated with high morbidity and mortality. Treatment and outcome are largely determined by the time of presentation. We performed a retrospective review of patients with esophageal perforation to assess the outcome of current management techniques. Material and Method: A retrospective chart review was performed on all patients treated for perforation of esophagus from March 1990 to March 2005. There were 28 patients (22 men and 6 women: mean age 51 years, range 17 to 82 years) The causes of the perforations were as follows: foreign body retention (9 patients), trauma (7 patients), spontaneous rupture (7 patients), and iatrogenic (5 pati-ients). 18 patients were presented within 24 hours and 10 patients were presented after 24 hours., Esophageal repair was performed in 21 ($75\%$) of them, 4 patients were treated with esophagectomy, 3 patients were treated with feeding gastrostomy and drainage. Result: Hospital mortality was $18\%$ and iatrogenic was increase the mortality rate (p < 0.05). Site of perforation, time from perforation, and treatment method had no influence on mortality. Postoprative leaks occurred in 4 patients after primary repair and were treated conservatively. Conclusion: Esophageal perforation remains a devastating event which is difficult to diagnose and manage. Primary repair can be performed in most patients with esophageal perforation regardless of time to presentation with a low mortality. Accurate diagnosis and early treatment are essential to the successful management of patients.

배경: 식도천공은 비교적 흔하지 않지만, 높은 이환율과 사망률을 나타낸다. 치료와 결과는 증상의 시간에 따라 크게 결정된다. 저자들은 식도천공 환자들을 최근의 치료방법으로 치료하여 결과를 후향적으로 조사하여 보았다 대상 및 방법: 1990년 3월부터 2005년 3월까지 식도 파열로 치료한 환자들을 후향적 분석하였다. 28명 환자들에서(남자 22명, 여자 6명: 평균나이 51세, 최소 17세에서 최고 82세)천공의 원인을 보면 이물질 9명, 외상 7명, 자연적 파열 7명, 의인성 5명이었다. 환자중 18명은 24시간 내 진단되었으며, 10명은 24시간 이후에 진단되었다. 21명($75\%$)에서 일차 봉합술을 시행하였으며, 4명에서는 식도 절제술, 3명의 환자에서는 위루술과 배농술를 시행하였다. 결과: 병원 사망률은 $18\%$이며, 그리고 의인성에서 사망률이 증가하였다(p <0.05). 천공위치, 천공 후 시간, 치료방법은 사망률에 영향을 미치지 못했다. 수술 후 누출은 4명의 환자에서 생겼으며, 보존적인 치료로 회복이 되었다. 결론: 식도 파열은 진단과 치료가 어렵기 때문에 아직도 위험한 질환이다. 대부분의 환자에서 증상의 발현시간에 관계없이 일차 재건술이 사망률을 낮출 수 있다. 정확한 진단과 조기 치료가 식도파열 환자들의 성공적인 치료에 필수적이다.

Keywords

References

  1. Okten I, Cangir AK, Ozdemir N, Kavukcy S, Yavuzer S, Akay H. Management of esophageal perforation. Surg Today 2001;31:36-9 https://doi.org/10.1007/s005950170217
  2. Jones WG, Ginsberg RJ. Esophageal perforation: a continuing challenge. Ann Thorac Surg 1992;53:534-43 https://doi.org/10.1016/0003-4975(92)90294-E
  3. Barrett N. Spontaneous perforation of the esophagus: review of the literature and a report of three new cases. Thorax 1946;1:48 https://doi.org/10.1136/thx.1.1.48
  4. Satinsky V, Kron SD. One-stage esophagectomy in the presence of mediastinitis. Arch Surg 1952;64:124-7 https://doi.org/10.1001/archsurg.1952.01260010135017
  5. Cho SJ. Shin JS, Hwang JJ, Choi YH, Kim HJ. Surgical treatment of esophageal perforation. Korean J Thorac Cardiovasc Surg 1994;27:598-602
  6. Kavic SM, Basson MD. Complications of endoscopy. Am J Surg 2001;181:319-30 https://doi.org/10.1016/S0002-9610(01)00589-X
  7. Pate JW, Walker WA, Cole FH Jr, Owen EW, Johnson WH. Spontaneous rupture of esophagus: a 30-year experience. Ann Thorac Surg 1989;47:689-92 https://doi.org/10.1016/0003-4975(89)90119-7
  8. Weiman DS, Walker WA, Broanan KM, Pate JW, Fabian TC. Noniatrogenic esophageal trauma. Ann Thorac Surg 1995;59:845-50 https://doi.org/10.1016/0003-4975(95)00008-9
  9. Venuta F, Rendiana EA, De Giacomo T, Ciccone AM, Mercadante E, Coloni GF. Esophageal perforation after sequencial double-lung transplantation. Chest 2000;117: 285-7 https://doi.org/10.1378/chest.117.1.117
  10. Sarr MG, Pemberton JH, Payne WS. Management of instrumental perforation of the esophagus. J Thorac Car diovasc Surg 1982;84:211-8
  11. Barrett N, Allison PR, Johnstone AS, Bonham-Carter RE. Discussion on unusual aspects of esophageal disease. Proc R Soc Med 1956;49:529
  12. Wang N, Razzouk AJ, Safavi A, et al. Delayed primary repair of intrathoracic esophageal perforation: is it safe? J Thorac Cardiovasc Surg 1996;111:114-22 https://doi.org/10.1016/S0022-5223(96)70407-5
  13. Han SY, McElvein RB, Aldrets JS, Tishler JM. Perforation of the esophagus: correlation of site and cause with plain film findings. Am J Roentgenol 1985;145: 537-40 https://doi.org/10.2214/ajr.145.3.537
  14. Panzini L, Burrell MI, Traube M. Instrumental esophageal perforation: chest film findings. Am J Gastroenterol 1994;89:367-40
  15. Pasricha PJ, Fleischer DE, Kalloo AN. Endoscopic perforation of the upper digestive tract: a review of their pathogenesis, prevention, and management. Gastroenterology 1994;106:787-802 https://doi.org/10.1016/0016-5085(94)90717-X
  16. Clayton J, Brinster BA, Singhal S, et al. Evolving options in the management of esophageal perforations. Ann Thorac Surg 2004;77:1475-83 https://doi.org/10.1016/j.athoracsur.2003.08.037
  17. Mengold L, Klassen KP. Conservative management of esophageal perforation. Arch Surg 1965;91:232-40
  18. Salo JA, Isolauri JO. Heikkila LJ, et al. Management of esophagectomy or primary repair. J Thorac Cardiovasc Surg 1993;106:1088-91
  19. Kotsis L, Kostic S, Zubovits K. Multimodality treatment of esophageal disruptions. Chest 1997;112:1304-9 https://doi.org/10.1378/chest.112.5.1304
  20. Whyte RI, Iannettoni MD, Orringer MB. Intrathoracic esophageal perforation. The merit of primary repair. J Thorac Cardiovasc Surg 1995;109:140-6 https://doi.org/10.1016/S0022-5223(95)70429-9