[食管置换。12年经验]

Avila L F, Luis A L, Encinas J L, Andrés A M, Suárez O, Martínez L, Fernández A, Queizán A, Murcia J, Olivares P, Lassaletta L, Tovar J A

Departamento de Cirugía Pediátrica, Hospital Infantil Universitario La Paz, Madrid.

Cir Pediatr. 2006 Oct;19(4):217-22.

UNLABELLED

Esophageal replacement is a surgical procedure rarely indicated in children. It is used in esophageal atresia type I and long-gap atresia when anastomosis is not possible, corrosive strictures and other unusual causes. Type and location of the graft depend on etiology and surgeon preferences. We analyse our results of a large series of esophageal replacement.

METHODS

. We reviewed esophageal replacements carried out in our department between January-1992 and December-2004. We report 29 patients (15 girls and 14 boys) with ages ranging from 2 months until 14 years old (median 24 months). 11 (37.9%) had esophageal atresia type I, 7 (24.1%) long-gap esophageal atresia, 8 (27.5%) caustic esophagitis, 1 herpetic esophagitis, 1 candida esophagitis and 1 esophageal necrosis due to sclerotherapy. Colon was used for substitution in 25 cases (86.2%) and stomach in 4 (13.8%). Graft location was retromediastinal in 25 children (86.2%), retrosternal in 3 and subcutaneous in 1. Native esophagus was removed in all but 2 out of 3 retrosternal cases.

RESULTS

After a follow up between 7 and 145 months (median 76 months) all children have a functional graft. Actually all patients tolerate oral feeding in a satisfactory way, and have had a normal pondostatural growth. Post-operative complications were pyloric obstruction in 3 patients (10.3%), upper anastomosis stricture in 3 (10.3%), 2 (6.9%) surgical wound evisceration, 2 (6.9%) diaphragmatic hernia, 1 (3.4%) retro-mediastinal abscess and 1 (3.4%) colo-gastric emptying difficulties. Also 2 pleural effusions, 1 cervical wound abscess and 1 abdominal wound one. Re-operation was needed in 11 patients (38%) due to these adverse events. Other complications were conservatively solved: 6 (20.7%) salivary fistula, 1 intestinal suboclusion and a dumping syndrome. One girl died due to a mycotic mediastinal abscess with perforation of the aorta 11 days after surgery. Overall survival was 96.5%.

CONCLUSIONS

Esophageal replacement has limited indications. It allow a good functional result, with adequate oral feeding and normal growth. We believe that both colon and stomach have similar outcomes, but gastric pull-up is easier to perform. It is a major surgery whose risk of complications is higher in early post-operative time.

未标注

食管置换术是一种在儿童中很少应用的外科手术。它用于I型食管闭锁和长段食管闭锁而无法进行吻合的情况、腐蚀性狭窄及其他特殊病因。移植物的类型和位置取决于病因及外科医生的偏好。我们分析了一系列食管置换术的结果。

方法

我们回顾了1992年1月至2004年12月在我科进行的食管置换术。我们报告了29例患者（15名女孩和14名男孩），年龄从2个月至14岁（中位年龄24个月）。11例（37.9%）为I型食管闭锁，7例（24.1%）为长段食管闭锁，8例（27.5%）为腐蚀性食管炎，1例为疱疹性食管炎，1例为念珠菌性食管炎，1例因硬化治疗导致食管坏死。25例（86.2%）用结肠进行替代，4例（13.8%）用胃进行替代。25例儿童（86.2%）的移植物位于后纵隔，3例位于胸骨后，1例位于皮下。除3例胸骨后病例中的2例之外，其余所有病例均切除了原食管。

结果

在7至145个月（中位时间76个月）的随访后，所有儿童的移植物均功能良好。实际上所有患者均能以令人满意的方式耐受经口喂养，且生长发育正常。术后并发症包括3例（10.3%）幽门梗阻，3例（10.3%）上吻合口狭窄，2例（6.9 %）手术切口裂开，2例（6.9%）膈疝，1例（3.4%）后纵隔脓肿和1例（3.4%）结肠-胃排空困难。另外还有2例胸腔积液、1例颈部伤口脓肿和1例腹部伤口脓肿。由于这些不良事件，11例患者（38%）需要再次手术。其他并发症通过保守治疗得到解决：6例（20.7%）唾液瘘，1例肠梗阻和1例倾倒综合征。1名女孩在术后11天因霉菌性纵隔脓肿伴主动脉穿孔死亡。总体生存率为96.5%。