目的:食管穿孔是一种复杂的临床情况,研究甚少。迄今为止,食管穿孔没有分级,原因是结果非常不同,因为穿孔非常异质。穿孔严重程度的分级可以指导治疗。并可能最终影响发病率和死亡率。
方法:本研究的观察期为4年。包括所有年龄在18至90岁之间的食管穿孔患者。排除食管手术后所有吻合口不足或瘘。分析损伤的原因以及事件与开始治疗之间的时间间隔。根据诊断性CT扫描的结果对每个穿孔的严重程度进行分类,胃镜检查以及临床和实验室检查结果。评估治疗和感染迹象。研究终点为患者康复或死亡。该研究是在杜塞尔多夫大学医院进行的回顾性单中心研究。该研究已获得审查委员会的批准。患者在数据收集前给予知情同意。使用SPSS29(IBMPSSStatistics软件)分析所有数据。
结果:年龄,性别和食管穿孔病因对总生存率无显著影响.损伤持续时间>24小时(p=0.01),纵隔炎(p=0.01)和食管坏死(p=0.02)的存在与不良结局相关.基于内镜下穿孔严重程度临床分级的相关性研究,放射学和临床发现与患者的总体生存率有显著差异.分为四个严重程度(I-IV)的患者的总生存率为100%,100%,70%和50%,分别。
结论:食管穿孔的严重程度可以根据放射学,诊断时的内镜和临床表现。由于分级及其与总生存率的相关性,患者的比较,他们的治疗和结果成为可能。在未来,穿孔的等级可以指导治疗,从而影响发病率和死亡率。
OBJECTIVE: Esophageal perforations are a complex clinical scenario that have been poorly studied. To date, there is no grading of esophageal perforations, the reason being that the outcome is very heterogeneous, because the perforation is very heterogeneous. A grading of the severity of the perforation may guide treatment, and could ultimately affect morbidity and mortality.
METHODS: The observation period of the study was four years. All patients with a perforation of the
esophagus aged 18 to 90 years were included. All anastomotic insufficiencies or fistulas after surgery of the
esophagus were excluded. The cause of the injury and the time interval between the event and the start of therapy were analyzed. The severity of each perforation was classified based on the results of a diagnostic CT scan, gastroscopy as well as clinical and laboratory findings. Therapy and signs of infection were evaluated. Endpoints of the study were patient recovery or death. The study was conducted as a retrospective single-center study at a university hospital of Düsseldorf. The study has been approved by the review board. Patients gave their informed consent before data collection. All data were analyzed using SPSS 29 (IBM SPSS Statistics software).
RESULTS: Age, gender and cause of the esophageal perforation did not impact significantly on overall survival. The duration of injury > 24 h (p = 0.01), presence of mediastinitis (p = 0.01) and necrosis of the
esophagus (p = 0.02) were associated with an unfavorable outcome. The correlation of the clinical grading of the severity of the perforation based on the endoscopic, radiological and clinical findings with the overall survival of patients was significant. Patients categorized into the four grades of severity (I-IV) had an overall survival of 100%, 100%, 70% and 50%, respectively.
CONCLUSIONS: The severity of esophageal perforations can be systematically rated grades I to IV based on the radiological, endoscopic and clinical findings at diagnosis. Due to the grading and its correlation to the overall survival, a comparison of patients, their treatment and outcome becomes possible. In future, the grade of a perforation may guide treatment, and therefore affect morbidity and mortality.