ПЕРФОРАЦИИ ПИЩЕВОДА: ДИАГНОСТИКА И ЛЕЧЕНИЕ
Аннотация
Введение. Оказание медицинской помощи пациентам с повреждением и несостоятельностью швов пищевода остается обсуждаемой и актуальной темой. Цель исследования – представить обзор литературы с результатами данных по диагностике и методам лечения перфораций пищевода (ПП), обратив особое внимание на группу пациентов с поздними сроками обращения, имеющих разного рода осложнения. Материал и методы. Проанализированы опубликованные отечественными и зарубежными авторами данные и представлены результаты лечения пациентов с ПП в отделении торакальной хирургии УЗ «Брестская областная клиническая больница». Результаты. Отражены литературные данные по лечению ПП с применением разных методик и представлены результаты лечения пациентов в отделении торакальной хирургии УЗ «Брестская областная клиническая больница» с применением оригинальной методики с установкой Т-образной разборной дренажной системы с формированием «контролируемой фистулы». Летальность пациентов при эндоскопических вмешательствах при ПП составила 10%. Выводы. При ПП, по данным разных авторов, общая летальность на сегодняшний день достигает 67%. Использование видеоторакоскопических вмешательств при ПП позволяет снизить летальность до 10%.Литература
Scheinin SA, Wells PR. Esophageal Perforation in a Sword Swallower. Texas Heart Institute Journal. 2001;28(1):65- 68.
Ferguson MK. Achalasia: Current evaluation and therapy. The Annals of Thoracic Surgery. 1991;52(2):336-342. https://doi.org/10.1016/0003-4975(91)91373-4.
Iannettoni MD, Vlessis AA, Whyte RI, Orringer MB. Functional Outcome after Surgical Treatment of Esophageal Perforation. The Annals of Thoracic Surgery. 1997;64(6):1606-1610. https://doi.org/10.1016/S0003-4975(97)01090-4.
Wesdorp IC, Bartelsman JF, Huibregtse K, den Hartog Jager FC, Tytgat GN. Treatment of instrumental oesophageal perforation. Gut. 1984;25(4):398-404. https://doi.org/10.1136/gut.25.4.398
Wu JT, Mattox KL, Wall MJ. Esophageal Perforations: New Perspectives and Treatment Paradigms. The Journal of Trauma: Injury, Infection, and Critical Care. 2007;63(5):1173- 1184. https://doi.org/10.1097/TA.0b013e31805c0dd4.
Abbas G, Schuchert MJ, Pettiford BL, Pennathur A, Landreneau J, Landreneau J, Luketich JD, Landreneau RJ. Contemporaneous management of esophageal perforation. Surgery. 2009;146(4):749-755. https://doi.org/10.1016/j.surg.2009.06.058.
Vaidya S, Prabhudessai S, Jhawar N, Patankar RV. Boerhaave’s syndrome: Thoracolaparoscopic approach. Journal of Minimal Access Surgery. 2010;6(3):76-79. https://doi.org/10.4103/0972-9941.68585.
Chikinev JuV, Drobjazgin EA, Poljakevich AS, Peshkova IV. Diagnostika i lechenie sindroma Burhave [Diagnostics and treatment of boerhaave’s syndrome]. Vestnik hirurgii im. I.I. Grekova [Grekov’s Bulletin of Surgery]. 2015;174(4):73-76. https://doi.org/10.24884/0042-4625-2015-174-4-73-76. (Russian).
Kimura T, Takemoto T, Fujiwara Y, Yane K, Shiono H. Esophageal perforation caused by a fish bone treated with surgically indwelling drainage and fibrin glue injection for fistula formation. Ann Thorac Cardiovasc Surg. 2013;19(4):289-292. https://doi.org/10.5761/atcs.cr.12.01906.
Chen Y-H, Li S-H, Chiu Y-C, Lu H-I, Huang C-H, Rau K-M, Liu C-T. Comparative study of esophageal stent and feeding gastrostomy/jejunostomy for tracheoesophageal fistula caused by esophageal squamous cell carcinoma. PLoS ONE. 2012;7(8):e42766. https://doi.org/10.1371/journal.pone.0042766.
Graeber GM, Niezgoda JA, Albus RA, Burton NA, Collins GJ, Lough FC, Zajtchuk R. A comparison of patients with endoscopic esophageal perforations and patients with Boerhaave’s syndrome. Chest. 1987;92(6):995-998. https://doi.org/10.1378/chest.92.6.995.
Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77(4):1475- 1483. https://doi.org/10.1016/j.athoracsur.2003.08.037.
Young CA, Menias CO, Bhalla S, Prasad SR. CT features of esophageal emergencies. Radiographics. 2008;28(6):1541- 1553. https://doi.org/10.1148/rg.286085520.
Gupta A, Rizvi I, Srivastava VK, Debnath J, Kapur BN, Khanna VN, Aziz A. Spontaneous pneumomediastinum. Medical Journal Armed Forces India. 2015;71(Suppl 1):S85-S88. https://doi.org/10.1016/j.mjafi.2013.03.008.
Ben-David K, Lopes J, Hochwald S, Draganov P, Forsmark C, Collins D, Chauhan S, Wagh MS, Carreras J, Vogel S, Sarosi G. Minimally invasive treatment of esophageal perforation using a multidisciplinary treatment algorithm: a case series. Endoscopy. 2011;43(2):160-162. https://doi.org/10.1055/s-0030-1256094.
Wahed S, Dent B, Jones R, Griffin SM. Spectrum of oesophageal perforations and their influence on management. Br J Surg. 2014;101(1):e156-162. https://doi.org/10.1002/bjs.9338.
Griffin SM, Lamb PJ, Shenfine J, Richardson DL, Karat D, Hayes N. Spontaneous rupture of the oesophagus. Br J Surg. 2008;95(9):1115-1120. https://doi.org/10.1002/bjs.6294.
Santos GH, Frater RW. Transesophageal irrigation for the treatment of mediastinitis produced by esophageal rupture. J Thorac Cardiovasc Surg. 1986;91(1):57-62. https://doi.org/10.1016/S0022-5223(19)38481-8.
Hinojar AG, Castejón MAR, Hinojar AA. Conservative management of a case of cervical esophagus perforation with mediastinal abscess and bilateral pleural effusion. Auris Nasus Larynx. 2002;29(2):199-201. https://doi.org/10.1016/S0385-8146(01)00145-6.
Loske G. Endoscopic negative pressure therapy of the upper gastrointestinal tract. Chirurg. 2019;90(Suppl 1):1-6. https://doi.org/10.1007/s00104-018-0727-x.
Mennigen R, Senninger N, Laukoetter MG. Novel treatment options for perforations of the upper gastrointestinal tract: Endoscopic vacuum therapy and over-the-scope clips. World J Gastroenterol. 2014;20(24):7767-7776. https://doi.org/10.3748/wjg.v20.i24.7767.
Biancari F, D’Andrea V, Paone R, Di Marco C, Savino G, Koivukangas V, Saarnio J, Lucenteforte E. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg. 2013;37(5):1051-1059. https://doi.org/10.1007/s00268-013-1951-7.
Persson S, Elbe P, Rouvelas I, Lindblad M, Kumagai K, Lundell L, Nilsson M, Tsai JA. Predictors for failure of stent treatment for benign esophageal perforations – a single center 10-year experience. World J Gastroenterol. 2014;20(30):10613-10619. https://doi.org/10.3748/wjg.v20.i30.10613.
Dasari BVM, Neely D, Kennedy A, Spence G, Rice P, Mackle E, Epanomeritakis E. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann. Surg. 2014;259(5):852-860. https://doi.org/10.1097/SLA.0000000000000564.
Koivukangas V, Biancari F, Meriläinen S, Ala-Kokko T, Saarnio J. Esophageal stenting for spontaneous esophageal perforation. J Trauma Acute Care Surg. 2012;73(4):1011-1013. https://doi.org/10.1097/TA.0b013e318265d176.
Freeman RK, Ascioti AJ, Giannini T, Mahidhara RJ. Analysis of unsuccessful esophageal stent placements for esophageal perforation, fistula, or anastomotic leak. Ann Thorac Surg. 2012;94(3):959-964. https://doi.org/10.1016/j.athoracsur.2012.05.047.
Sharma P, Kozarek R. Role of esophageal stents in benign and malignant disease. Am J Gastroenterol. 2010;105(2):258-273. https://doi.org/10.1038/ajg.2009.684.
Babor R, Talbot M, Tyndal A. Treatment of upper gastrointestinal leaks with a removable, covered, self-expand- ing metallic stent. Surg Laparosc Endosc Percutan Tech. 2009;19(1):e1-4. https://doi.org/10.1097/SLE.0b013e318196c706.
Muir AD, White J, McGuigan JA, McManus KG, Graham AN. Treatment and outcomes of oesophageal perforation in a tertiary referral centre. Eur J Cardiothorac Surg. 2003;23(5):799-804. https://doi.org/10.1016/s1010-7940(03)00050-2.
Hasimoto CN, Cataneo C, Eldib R, Thomazi R, Pereira RS de C, Minossi JG, Cataneo AJM. Efficacy of surgical versus conservative treatment in esophageal perforation: a systematic review of case series studies. Acta Cir Bras. 2013;28(4):266-271. https://doi.org/10.1590/s0102-86502013000400006.
Vogel SB, Rout WR, Martin TD, Abbitt PL. Esophageal Perforation in Adults: Aggressive, Conservative Treatment Lowers Morbidity and Mortality. Annals of Surgery. 2005;241(6):1016-1023. https://doi.org/10.1097/01.sla.0000164183.91898.74.
Kaman L, Iqbal J, Kundil B, Kochhar R. Management of Esophageal Perforation in Adults. Gastroenterology Research. 2010;3(6):235-244. https://doi.org/10.4021/gr263w.
Collins C, Arumugasamy M, Larkin J, Martin S, O’Sullivan GC. Thoracoscopic repair of instrumental perforation of the oesophagus: first report. Ir J Med Sci. 2002;171(2):68-70. https://doi.org/10.1007/BF03168953.
Jougon J, Mc Bride T, Delcambre F, Minniti A, Velly J-F. Primary esophageal repair for Boerhaave’s syndrome whatever the free interval between perforation and treatment. Eur J Cardiothorac Surg. 2004;25(4):475-479. https://doi.org/10.1016/j.ejcts.2003.12.029.
Tettey M, Edwin F, Aniteye E, Sereboe L, Tamatey M, Entsua-Mensah K, Kotei D, Frimpong-Boateng K. Management of intrathoracic oesophageal perforation: analysis of 16 cases. Trop Doct. 2011;41(4):201-203. https://doi.org/10.1258/td.2011.110120.
Kiss J. Surgical treatment of oesophageal perforation. British Journal of Surgery. 2008;95(7):805-806. https://doi.org/10.1002/bjs.6209.
Richardson JD. Management of esophageal perforations: the value of aggressive surgical treatment. Am J Surg. 2005;190(2):161-165. https://doi.org/10.1016/j.amjsurg.2005.05.004.
Kollmar O, Lindemann W, Richter S, Steffen I, Pistorius G, Schilling MK. Boerhaave’s syndrome: primary repair vs. esophageal resection--case reports and meta-analysis of the literature. J Gastrointest Surg. 2003;7(6):726-734. https://doi.org/10.1016/s1091-255x(03)00110-0.
Lindenmann J, Matzi V, Neuboeck N, Anegg U, Maier A, Smolle J, Smolle-Juettner FM. Management of esophageal perforation in 120 consecutive patients: clinical impact of a structured treatment algorithm. J Gastrointest Surg. 2013;17(6):1036-1043. https://doi.org/10.1007/s11605-012-2070-8.
Gouge TH, Depan HJ, Spencer FC. Experience with the Grillo pleural wrap procedure in 18 patients with perforation of the thoracic esophagus. Ann Surg. 1989;209(5):612-617. https://doi.org/10.1097/00000658-198905000-00014.
Mahmodlou R, Abdirad I, Ghasemi-rad M. Aggressive Surgical Treatment in Late-Diagnosed Esophageal Perforation: A Report of 11 Cases. ISRN Surgery. 2011;2011:1-4. https://doi.org/10.5402/2011/868356.
Abbott OA, Mansour KA, Logan WD, Hatcher CR, Symbas PN. Atraumatic so-called „spontaneous” rupture of the esophagus. A review of 47 personal cases with comments on a new method of surgical therapy. J Thorac Cardiovasc Surg. 1970;59(1):67-83. https://doi.org/10.1016/S0022-5223(19)42515-4.
Port JL, Kent MS, Korst RJ, Bacchetta M, Altorki NK. Thoracic esophageal perforations: a decade of experience. The Annals of Thoracic Surgery. 2003;75(4):1071-1074. https://doi.org/10.1016/s0003-4975(02)04650-7.
Linden PA, Bueno R, Mentzer SJ, Zellos L, Lebenthal A, Colson YL, Sugarbaker DJ, Jaklitsch MT. Modified T-tube repair of delayed esophageal perforation results in a low mortality rate similar to that seen with acute perforations. Ann Thorac Surg. 2007;83(3):1129-1133. https://doi.org/10.1016/j.athoracsur.2006.11.012.
Okonta KE, Kesieme EB. Is oesophagectomy or conservative treatment for delayed benign oesophageal perforation the better option? Interact Cardiovasc Thorac Surg. 2012;15(3):509-511.https://doi.org/10.1093/icvts/ivs190.
Arciaga PL, Windokun A, Wood W, Frost EAM. Аnesthetic management of iatrogenic esophageal perforation--case report and literature review. Middle East J Anaesthesiol. 2007;19(1):231-242.
Cho JS, Kim YD, Kim JW, I HS, Kim MS. Thoracoscopic primary esophageal repair in patients with Boerhaave’s syndrome. Ann Thorac Surg. 2011;91(5):1552-1555. https://doi.org/10.1016/j.athoracsur.2011.01.082.
Landen S, Nakadi El. Minimally invasive approach to Boerhaave’s syndrome: a pilot study of three cases. Surg Endosc. 2002;16(9):1354-1357. https://doi.org/10.1007/s00464-001-9185-4.
Nguyen NT, Follette DM, Roberts PF, Goodnight JE. Thoracoscopic management of postoperative esophageal leak. J Thorac Cardiovasc Surg. 2001;121(2):391-392. https://doi.org/10.1067/mtc.2001.110485.
Scott HJ, Rosin RD. Thoracoscopic repair of a transmural rupture of the oesophagus (Boerhaave’s syndrome). J R Soc Med. 1995;88(7):414P-415P.
