Özofagus perforasyonlarýnda tedavi: On bir olgunun analizi

AMAÇ
Kliniðimizde tedavi uygulanan özofagus perforasyonlu 11 olgu, özellikle cerrahi tedavinin önemini vurgulamak için sunuldu.
GEREÇ VE YÖNTEM
Bu çalýþmada, 2005-2010 yýllarý arasýnda özofagus perforasyonu nedeni ile tedavi uygulanan 11 olgu geriye dönük olarak incelendi. Ýlk 24 saat içerisinde taný konulan olgular erken, daha sonra taný konulanlar ise geç taný olarak deðerlendirildi.
BULGULAR
Olgularýn yaþ ortalamasý 45,8 idi. Olgulardan 3’üne perforasyon oluþtuktan sonra erken, diðerlerine ise geç dönemde taný konuldu. Erken taný konulan 3 olguya primer onarým, geç taný konulan 8 olgunun 4’üne primer onarým, 2’sine kolon interpozisyonu, 1’ine stent uygulama ve 1 olguya ise medikal tedavi uygulandý. Geç taný konulan olgularýn tümüne drenaj yapýldý. Erken tedavi edilen 3 olgu komplikasyonsuz olarak iyileþti. Diðer 8 olgunun 1’inde anastomoz kaçaðý, 1’inde ise fistül geliþti. Ýki olgu hayatýný kaybetti. Mortalite %18,1 olarak bulundu.
SONUÇ
Özofagus perforasyonlarýnda mediastinit geliþmeden yapýlacak olan müdahale hayat kurtarýcýdýr. Yaralanmadan sonra 72 saate kadar yapýlacak olan ve primer onarýmý içeren cerrahi tedavinin iyi sonuçlar verdiðini düþünmekteyiz.

Treatment for esophageal perforations: analysis of 11 cases

BACKGROUND
We present 11 cases with esophageal perforations who were treated in our department, with the intent of underlining the importance of surgical intervention.
METHODS
We retrospectively analyzed 11 cases of esophageal perforation who were treated from 2005 to 2010. The cases diagnosed within the first 24 hours were regarded as early diagnoses; those diagnosed later than this period were regarded as late diagnoses.
RESULTS
The mean age of the patients was 45.8 years. Following the perforation, 3 of the patients had early diagnoses and the others had late diagnoses. Of the 3 cases with early diagnosis, all had primary repair; of the late diagnosis cases, 4 had primary repair, 2 had colonic interposition, 1 had stent implantation, and 1 received medical treatment. All the cases with late diagnoses underwent drainage. The 3 cases who received early treatment recovered without complications. Of the other 8 cases, 1 had leakage from the anastomosis and 1 developed a fistula. Two (18.1%) of our patients died.
CONCLUSION
Treatments performed before the development of mediastinitis are lifesaving in esophageal perforation patients. We think that surgical treatment performed within the first 72 hours that includes primary repair would yield favorable results.