頚部食道穿孔とその対応策 自験例提示と文献的考察

Abstract

Esophageal perforation is associated with high morbidity and mortality because of high incidence of combined infection in the neck and mediastinum. It could occur at any level of the esophagus, but is most commonly seen at the cervical esophagus and the cardia.The most common cause of cervical esophageal perforation is a damage to the wall by the instrumentation with esophagoscopy or esophageal dilation-bouginage.We have experienced two cases of cervical esophageal perforation in the last ten years. In one case, it occurred during esophagoscopy, and in another case, during esophageal dilation-bouginage.The key for the success in the management of esophageal perforation is an earlier detection and proper treatment. The most useful diagnostic tests are X-ray examinations of the neck and thorax, including fluoroscopy of the esophagus.Cervical esophageal perforation should be surgically treated as soon as possible regardless of the cause. When an operation is performed promptly, and the tissue adjacent to the perforation appears normal, primary repair is possible.This must be supplemented with antibiotics. If the primary repair is not possible a lateral esophagostomy is recommended in order to divert saliva.From our experiences, it should be emphasized that the success in the management of cervical esophageal perforation depends on prompt diagnosis and earlier treatment.