Aziz Dalal, Schiller Dan, Gerstle Justin T, Ein Sigmund H, Langer Jacob C
Division of General Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
J Pediatr Surg. 2003 May;38(5):705-8. doi: 10.1016/jpsu.2003.50188.
Neonates with "long gap" esophageal atresia (EA) are often managed with gastrostomy and tube drainage of the proximal pouch for a number of months while awaiting definitive repair. Because of the risk of aspiration and need for complex nursing care, most remain hospitalized during this time. However, prolonged hospitalization utilizes scarce resources and may be difficult for many families.
The authors report on 5 patients who were treated successfully at home while awaiting esophageal anastomosis.
Four patients had pure EA (one had a duodenal atresia), and one had a distal fistula. Gestational ages ranged from 31 to 41 weeks. All had a gastrostomy within days of birth. Age at definitive repair ranged from 6 to 12 months. Time at home while awaiting anastomosis ranged from 42 to 113 days. Care at home included nursing care, suction equipment and training, gastrostomy feeding, and ability to perform cardiopulmonary resuscitation. The only complications noted while at home consisted of ear infection in one patient and recurrent upper respiratory tract infections in another patient.
Selected patients with long gap esophageal atresia can be treated safely at home while awaiting esophageal anastomosis. Success of this approach depends on a motivated, reliable family, and adequate support from community health care providers.
患有“长段间隙”食管闭锁（EA）的新生儿在等待最终修复期间，通常要进行胃造瘘术并对近端盲袋进行数月的置管引流。由于存在误吸风险且需要复杂的护理，大多数患儿在此期间仍需住院。然而，长期住院会消耗稀缺资源，对许多家庭来说也可能困难重重。
作者报告了5例在等待食管吻合术期间在家中成功接受治疗的患者。
4例为单纯食管闭锁（1例合并十二指肠闭锁），1例合并远端瘘。胎龄为31至41周。所有患儿均在出生后数天内进行了胃造瘘术。最终修复时的年龄为6至12个月。等待吻合术期间在家中的时间为42至113天。在家中的护理包括护理、吸引设备及培训、胃造瘘喂养以及实施心肺复苏的能力。在家中期间记录到的唯一并发症为1例患儿耳部感染，另1例患儿反复出现上呼吸道感染。
部分长段间隙食管闭锁患者在等待食管吻合术期间可在家中得到安全治疗。这种方法的成功取决于积极主动、可靠的家庭以及社区医疗服务提供者的充分支持。
