Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Clinical Analysis and Treatment of Esophageal Perforation

식도천공의 치료 및 임상고찰

  • Park, Hoon (Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine) ;
  • Park, Nam-Hee (Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine) ;
  • Park, Chang-Kwon (Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine) ;
  • Lee, Kwang-Sook (Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine) ;
  • Keum, Dong-Yoon (Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine)
  • 박훈 (계명대학교 의과대학 동산의료원 흉부외과학교실) ;
  • 박남희 (계명대학교 의과대학 동산의료원 흉부외과학교실) ;
  • 박창권 (계명대학교 의과대학 동산의료원 흉부외과학교실) ;
  • 이광숙 (계명대학교 의과대학 동산의료원 흉부외과학교실) ;
  • 금동윤 (계명대학교 의과대학 동산의료원 흉부외과학교실)
  • Published : 2006.02.01
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Abstract

Background: Perforation of the esophagus is a deadly injury that requires expert management for survival. The mediastinal contamination with microorganisms, gastric acid, and digestive enzymes results in a mediastinitis that is often fatal if untreated. Material and Method: Between January 1990 and June 2004, 38 patients with esophageal perforation were treated in our hospital. Retrospective review of these cases has been performed. Result: There were 28 males and 10 females. The mean age was 43.84$\pm$18.89 years (range $1{\~}73$ years). Spontaneous rupture was found in $34\%$ of perforations, iatrogenic perforation in $32\%$ and traumatic perforation in $34\%$. Perforation occurred in the cervical esophagus in 8 cases, thoracic esophagus in 29 and abdominal esophagus in 1. In the cervical esophageal perforation, managements were primary closure in 8 and drainage in 2. In the thoracic esophageal perforation, managements were primary closure in 14, resection in 3 and conservative management in 12. The mortality rate was $25\%$ in cervical esophageal perforation and $34.5\%$ in thoracic esophageal perforation. We revealed risk factor of esophageal perforation to be peropertaive septic condition (p=0.005). Conclusion: Most important risk factor of esophageal perforation was preoperative septic condition. Preoperative prompt and aggressive preoperative treatment may improve the survival rate of esophageal perforation.

배경: 식도천공은 즉시 진단되어 치료하지 않으면 높은 이병률과 사망률을 보인다. 수술 방법의 진보에도 불구하고 식도천공의 치료의 시기와 방법은 아직 논쟁의 여지가 많은 상태이다. 대상 및 방법: 1990년 1월에서 2004년 6월까지 계명대학교 동산의료원에서 식도 천공을 진단받은 38명의 환자에서 차트를 이용하여 후향적 조사를 하였다. 결과: 환자는 남자가 28명, 여자가 10명이었고 평균 연령은 43.84$\pm$18.89세($1{\~}73$세)였다. 천공은 경부에서 8예, 흉부가 28예 그리고 복부가 1예 발생하였고 자연성 식도 천공이 $34\%$, 의인성이 $32\%$ 그리고 외상성이 $34\%$로 조사되었다. 치료는 경부식도 천공에서는 일차봉합 6예, 배농만 시행한 경우가 2예였으며, 흥부식도 천공에서는 일차봉합 14예, 식도 절제술 3예 그리고 보존적 치료가 12예였다. 사망률은 경부 식도 파열이 $25\%$, 흉부식도 파열이 $34\%$였다. 환자의 생존에 유의한 위험인자는 술 전의 패혈증 여부로 나타났다. 결론: 식도파열에서 가장 중요한 위험인자가 술 전의 패혈증 상태로 나타났다 술 전에 상태를 호전시킬 수 있는 적극적인 치료가 예후를 향상시킬 수 있을 것이다.

Keywords

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