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非医源性创伤性食管穿孔的治疗

Author
Daniel P Raymond, MD
Section Editor
Joseph S Friedberg, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
常英, 主任医师

引言

食管的非医源性穿透伤是一种罕见却危及生命的疾病[1,2]。若损伤邻近结构如气管，以及诊断延误24小时，则导致结局不良。一期手术修复是最成功的治疗方法[3]。

大多数食管穿孔是医源性的[3]。非医源性食管穿孔的最常见原因是自发性破裂，其次是异物吞入(表 1)、创伤和恶性肿瘤(表 2)[3]。自发性食管破裂(Boerhaave综合征)和异物引起的食管穿孔见其他专题。 (参见“Boerhaave综合征：压力性食管破裂”和“Ingested foreign bodies and food impactions in adults”和“儿童食管及胃肠道异物”)

患病率和病因学

创伤性食管损伤罕见，大多数的大型创伤中心每年只收治1-2例。例如，在美国34个创伤中心的回顾性调查中，10年间只有433例穿透性食管损伤的报告[1]。国家创伤数据库2年间的同期分析发现227例穿透性食管损伤的报告，数据来自77所一级创伤中心和20所二级创伤中心[4]。此外，一份苏格兰创伤审计组(Scottish Trauma Audit Group ，STAG)的回顾性评价发现食管损伤的年发病率是每年0.95/100万[5]。

大部分食管损伤为穿透伤[6]。美国的一些研究显示，外伤性破裂最常见的病因是枪击(75%)，其次是刺伤和其他机制损伤[1,6]。在一项包括1921例经纵隔枪伤患者的病例系列研究中，食管损伤者不到1%[7]。然而，在STAG研究中，57%的食管穿孔是由于钝挫伤，43%则是穿透性创伤引起的[5]。

颈段食管损伤是非医源性创伤性穿孔最常见的位置，累及一个以上解剖位置的(例如，颈段和胸段)不足5%(图 1和图 2和图 3和图 4和图 5)[1]。尽管在食管任何部位穿透性创伤时所有邻近结构均面临损伤的风险，但最常累及的相邻部位是气管(75%)[6]。食管穿孔合并气管穿孔是一种不常见但有可能危及生命的损伤。大多数患者很可能死于意外事件现场或穿入伤[8]。一项有关14项回顾性研究共27例患者的meta分析显示，那些幸存并被送往医院的患者紧急手术治疗后未发现死亡[9]。

           

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Literature review current through: 2017-06 . | This topic last updated: 2016-04-08.
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