Cavallaro S, Pineschi A, Freni G, Cortese M G, Bardini T
Department of Pediatric Surgery, Regina Margherita Children's Hospital, Torino, Italy.
Eur J Pediatr Surg. 1992 Apr;2(2):73-7. doi: 10.1055/s-2008-1063406.
Severe feeding troubles were recorded in five babies with long-gap esophageal atresia who underwent, between 1985 and 1990, a delayed primary anastomosis after spontaneous growth of their esophageal stumps. A comparison with 20 cases of direct esophageal anastomosis, operated on in the same period, was carried out by means of recorded esophagrams, pH monitoring and questionnaires charting the growth pattern and feeding habits of the patients. Bottle feeding, and, later on, the introduction of semi-solid foods was significantly retarded in the group of children with delayed primary anastomosis (labeled as group B) as well as height and weight parameters. Failure to complete feeds, dysphagia, vomiting, coughing, choking and recurrent respiratory symptoms were also significantly more common in this group than in the primary anastomosis group (labeled as group A) even in the absence of stricture. Variable degrees of disordered esophageal motility were present in all patients but pooling of the contrast medium, retrograde flow and delayed clearing of the esophagus were more frequent in group B. No patient was shown to have associated hiatal hernia. A 24 hour pH recording showed severe gastroesophageal reflux in 4 out of 13 cases of group A and in 3 out of 5 cases of group B. Clearing times were significantly delayed in all refluxing children. Our data suggest that the retarded start of oral feeding and swallowing coordination in patients with delayed primary anastomosis add further negative factors to their congenitally impaired esophageal motility, causing protracted dysphagia which represents a major problem for both family and hospital staff.
1985年至1990年间，对5例患有长间隙食管闭锁的婴儿进行了食管残端自然生长后的延迟一期吻合术，记录到了严重的喂养问题。通过记录食管造影、pH监测以及记录患者生长模式和喂养习惯的问卷，与同期进行直接食管吻合术的20例患者进行了比较。在延迟一期吻合术组（标记为B组）中，奶瓶喂养以及随后引入半固体食物明显延迟，身高和体重参数也是如此。即使在没有狭窄的情况下，该组中未完成喂养、吞咽困难、呕吐、咳嗽、窒息和反复出现的呼吸道症状也比一期吻合术组（标记为A组）明显更常见。所有患者均存在不同程度的食管动力障碍，但B组中造影剂潴留、逆流和食管清除延迟更为常见。未发现患者伴有食管裂孔疝。24小时pH记录显示，A组13例中有4例、B组5例中有3例存在严重胃食管反流。所有反流儿童的清除时间均明显延迟。我们的数据表明，延迟一期吻合术患者口服喂养和吞咽协调开始延迟，给其先天性受损的食管动力增加了更多负面因素，导致持续性吞咽困难，这对家庭和医院工作人员来说都是一个主要问题。
