Journal of Chest Surgery

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

식도천공의 수술적 치료의 임상결과와 위험인자 분석

  • Cho, Sung-Woo (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Hong, Ki-Woo (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Kim, Shin (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Lee, Hee-Sung (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Kim, Hyoung-Soo (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Lee, Jae-Woong (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Choi, Goang-Min (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Shin, Yoon-Cheol (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Shin, Ho-Seung (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Lee, Won-Yong (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University)
  • 조성우 (한림대학교 의과대학 흉부외과학교실) ;
  • 홍기우 (한림대학교 의과대학 흉부외과학교실) ;
  • 김신 (한림대학교 의과대학 흉부외과학교실) ;
  • 이희성 (한림대학교 의과대학 흉부외과학교실) ;
  • 김형수 (한림대학교 의과대학 흉부외과학교실) ;
  • 이재웅 (한림대학교 의과대학 흉부외과학교실) ;
  • 최광민 (한림대학교 의과대학 흉부외과학교실) ;
  • 신윤철 (한림대학교 의과대학 흉부외과학교실) ;
  • 신호승 (한림대학교 의과대학 흉부외과학교실) ;
  • 이원용 (한림대학교 의과대학 흉부외과학교실)
  • Published : 2008.06.05
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Abstract

Background: Esophageal perforation is an emergency that. requires early diagnosis and effective treatment. A delay in diagnosis and treatment. significantly increases morbidity and mortality. Material and Method: Thirty-seven patients with esophageal perforation were surgically treated at our institutions between January 1990 and December 2006. We retrospectively reviewed the results of surgical treatment for esophageal perforation to understand the risk factors affecting survival inpatients. Result: Patients ranged in age from 21 to 87 years, with an average age of $52.7{\pm}16.98$ years. Thirty-one of the patients were men and six were women. There were 23 patients (62%) with spontaneous perforations, 10 patients (27%) with a traumatic perforation, and 4 patients (11%) with an iatrogenic perforation. The site of esophageal perforation was the cervical esophagus in 5 patients, the thoracic esophagus in 31 patients, and the abdominal esophagus in one patient. Twenty-nine patients underwent primary closure of the perforation and five patients had T-tube drainage. Exclusion-diversion procedures were performed in two patients and an esophagectomy was performed in one patient. There were six cases of mortality (16.22%) and 25 cases of postoperative complications in 15 patients (40.5%). Patients that were treated later than 24 hours after detection of the perforation showed a statistically significant high morbidity and mortality rate (p<0.05). Conclusion: The most important risk factor of esophageal perforation was the time interval between detection of the perforation and the initiation of treatment. A prompt diagnosis and effective treatment are necessary to decrease morbidity and mortality.

배경: 식도천공은 빠른 진단과 효과적인 치료를 요하는 응급상황이다. 잘못된 진단과 치료의 지연은 이환율과 사망률을 증가시킨다. 대상 및 방법: 1990년 1월부터 2006년 12월까지 본 의료원 병원들에서 수술한 식도천공 환자는 37명을 대상으로 환자의 생존에 영향을 미치는 인자를 알아보기 위해 식도천공의 수술적 치료결과를 후향적으로 조사하였다. 결과: 환자의 연령분포는 21세에서 87세까지 이었고 평균 연령은 $52.7{\pm}16.98$세이었다. 남자가 31명, 여자가 6명이었다. 자연성 천공인 경우가 23 예(62%)이었고 외상성 경우가 10예(27%), 의인성인 경우가 4예(11%)이었다. 식도천공의 위치는 경부가 5예, 흉부가 31예, 복부가 1예 이었다. 식도 일차봉합술은 29예의 환자에게 시행하였고 5예의 환자에서는 T-tube 배액술을 시행하였다. 배제술과 전환술은 2예, 식도제거술은 1예에서 시행하였다. 6명의 환자가 사망하였고(16.22%) 15명의 환자에서(40.5%) 25예의 술 후 합병증이 있었다. 천공 후 치료까지의 시간이 24시간 이상인 군이 사망률과 이환율이 유의하게 높았다(p<0.05). 결론: 식도천공의 가장 중요한 위험인자는 천공에서 치료시작까지의 소요시간이었다. 사망률과 이환율을 낮추기 위해 신속한 진단과 효과적인 치료가 필요하다.

Keywords

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