Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Clinical Evaluation of Instrumental Esophageal Perforation

기구에 의한 식도천공에 대한 임상적 고찰

  • Sa Young-Jo (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kang Chul-Ung (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Cho Kyu-Do (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park Kuhn (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Wang Young-Pil (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park Jae-Kil (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 사영조 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 강철웅 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 조규도 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 박건 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 왕영필 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 박재길 (가톨릭대학교 의과대학 성모병원 흉부외과학교실)
  • Published : 2006.05.01
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Abstract

Background: Esophageal perforation is an uncommon problem, but it is associated with high mortality. We performed a retrospective review of patients with instrumental esophageal perforation to assess the outcome of current management techniques. Material and Method: We retrospectively analyzed all cases of instrumental esophageal perforation diagnosed at our hospital from January 1999 through to March 2005. The study group consisted of 12 patients (8 women and 4 men) with a mean age of 48.8 years (range, $21{\sim}83$ years). We reviewed the effects of the surgical or medical treatments in various conditions of patients, such as of various sites of perforation and time delayed after injury. Result: Perforations were due to diagnostic endoscopy (50.0%, 6/12), esophageal bougination for benign stricture (33.3%, 4/12), endoscopic port insertion (8.3%, 1/12), and tracheal intubation (8.3%, 1/12). The perforated sites were thoracic in 7 patients and cervical in 5. The treatment included resection and reconstruction (5 cases), incision and drainage (4 cases), medical treatment (2 cases), and closed thoracostomy drainage only (1 case). Post-operative complications of transient pneumonia and wound infection were developed in 1 patient respectively. Both occurred in two patients with diffuse mediastinal abscess formation. The overall mortality was 8.3% (1/12) in one old patient who was managed medically for cervical esophageal perforation. Conclusion: We concluded that surgical treatment for esophageal perforations was safe and effective whether diagnosed early or lately.

배경: 위내시경 검사나 기관삽관 시 식도 손상에 의한 식도 천공례는 대단히 드물다. 그러나 식도 천공의 발생 시 신속한 처치가 이루어지지 않는다면 예후는 매우 불량하다. 저자들은 기구에 의한 식도 천공례에서 기존 치료에 대한 효과를 알아보기 위하여 후향적 분석을 시행하였다. 대상 및 방법:1999년 1월부터 2005년 3월까지 저자들이 치험하였던 기구에 의한 식도 천공환자 12예를 대상으로 하였다. 천공의 원인과 부위, 내원까지의 지연 시간, 그리고 치료방법 등에 따른 예후 등을 분석하였다. 결과: 위내시경 검사에 의한 천공이 6예로 가장 많았으며(50.0%), 식도확장술에 의한 경우가 4예(33.3%), 그리고 내시경 포트삽입술과 기관삽관에 의한 경우가 각각 1예(8.3%)씩 있었다. 이 중 7예가 흉부 식도의 천공이었으며, 5예가 경부 식도의 천공이었다. 치료 방법으로는 식도절제 및 재건술이 5예, 절개 및 배농술이 4예, 폐쇄성 흉강 삽관술이 1예, 그리고 내과적 치료가 2예였다. 수술에 의한 위중한 합병증은 없었으며, 경미한 폐렴과 창상 감염이 각각 1예에서 발생되었다. 수술을 거부하여 내과적 치료를 시행하였던 1예에서 사망하여 사망률은 8.3%이었다. 결론: 기구에 의한 식도 천공에서 부위와 지연 시간에 상관없이 외과적 수술은 안전하며 또한 효과적인 치료방법이라고 생각되었다.

Keywords

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