Morabito Antonio, Lall Anupam, Lo Piccolo R, McCarthy Helen, Kauffmann Lisa, Ahmed Shiban, Bianchi Adrian
Department of Paediatric Surgery, Central Manchester and Manchester Children's University Hospitals, Manchester, M27 4HA, UK.
J Pediatr Surg. 2006 May;41(5):919-22. doi: 10.1016/j.jpedsurg.2006.01.013.
Neurologically impaired children run a 12% to 45% risk of recurrent gastroesophageal reflux (GER) after fundoplication. Elimination of the reflux by "rescue" total esophagogastric dissociation (TEGD) encouraged us to use it also as a "primary" form of antireflux surgery in this group of patients.
Twenty-six (14 male, 12 female) patients underwent TEGD between 1994 and 2004, of which 16 were primary and 10 were rescue procedures for failed fundoplication.
There was no operative mortality and postoperative complications were limited to one subphrenic collection, one esophagojejunal dehiscence, and one small bowel hernia beneath the jejunal Roux loop. Gastrostomy feeding was usually established by 3 to 5 days and the mean hospital stay was 10.2 days (range, 6-18 days). At follow-up of 7 months to 11 years, there was no recurrence of GER. Four late deaths were unrelated to the surgery. The children's nutritional status improved with the mean weight standard deviation score showing a statistically significant increase from -2.63 preoperatively to -0.96 postoperatively (Wilcoxon's signed rank P value < or =.005).
Total esophagogastric dissociation is a safe definitive solution for GER because it eliminates all risk of recurrent reflux. We therefore feel that TEGD can be used as a primary treatment of choice for severely neurologically impaired patients who are experiencing GER and are completely dependant on tube feeds.
神经功能受损儿童在胃底折叠术后有12%至45%的复发性胃食管反流（GER）风险。通过“挽救性”全食管胃分离术（TEGD）消除反流促使我们在这组患者中将其也用作抗反流手术的“初次”形式。
1994年至2004年间，26例（14例男性，12例女性）患者接受了TEGD，其中16例为初次手术，10例为胃底折叠术失败后的挽救性手术。
无手术死亡，术后并发症仅限于1例膈下积液、1例食管空肠裂开和1例空肠Roux袢下小肠疝。通常在3至5天内建立胃造口喂养，平均住院时间为10.2天（范围6 - 18天）。在7个月至11年的随访中，GER无复发。4例晚期死亡与手术无关。儿童营养状况改善，平均体重标准差评分从术前的 - 2.63显著增加至术后的 - 0.96（Wilcoxon符号秩检验P值≤0.005）。
全食管胃分离术是GER的一种安全的确定性解决方案，因为它消除了复发性反流的所有风险。因此，我们认为TEGD可作为患有GER且完全依赖管饲的严重神经功能受损患者的首选初始治疗方法。
