Gottrand F, Sfeir R, Coopman S, Deschildre A, Michaud L
Centre de référence des affections congénitales et malformatives de l'oesophage, clinique de pédiatrie, hôpital Jeanne-de-Flandre, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
Arch Pediatr. 2008 Dec;15(12):1837-42. doi: 10.1016/j.arcped.2008.09.027. Epub 2008 Nov 8.
Although initial prognosis of oesophageal atresia is nowadays excellent with more than 95% of survival, the long-term complications are frequent. A gastro-oesophageal reflux is found in 26 to 75% of the cases, responsible for peptic oesophagitis, anastomotic stenosis and Barrett's oesophagus, risk factor of adenocarcinoma of the oesophagus. A dysphagia is frequently observed on these patients, sometimes several years after the surgery, observed in almost 45% of five-year-old children. Growth retardation is found in nearly a third of these children. Respiratory symptoms are particularly frequent, especially in the first years, associating tracheomalacia facilitating the bronchopulmonary infectious episodes (found in about 30% of 5-year-old children). Esotracheal fistula recurrence is very rare. A deformation of the rib cage is reported in 20%, and a scoliosis in 10% of the patients. However, the quality of life of these patients in the adulthood is good, and influenced by the existence of associated malformations. Even if the current prognosis of oesophageal atresia is good altogether, the frequency of the complications (digestive, respiratory, nutritional, orthopaedic) far from the initial intervention, and the necessity of a surveillance of the secondary oesophageal damages, justifies a systematic and multidisciplinary follow-up until adulthood.
尽管如今食管闭锁的初始预后极佳,生存率超过95%,但其长期并发症却很常见。26%至75%的病例存在胃食管反流,可导致消化性食管炎、吻合口狭窄和巴雷特食管,而巴雷特食管是食管癌的危险因素。这些患者经常出现吞咽困难,有时在手术后数年出现,近45%的5岁儿童存在这种情况。近三分之一的此类儿童存在生长发育迟缓。呼吸症状尤其常见,特别是在最初几年,常伴有气管软化,易引发支气管肺部感染(约30%的5岁儿童存在)。食管气管瘘复发非常罕见。20%的患者报告有胸廓畸形,10%的患者有脊柱侧弯。然而,这些患者成年后的生活质量良好,但会受到相关畸形存在与否的影响。即使目前食管闭锁的总体预后良好,但远离初始干预时并发症(消化、呼吸、营养、骨科)的发生率,以及对继发性食管损伤进行监测的必要性,都说明有必要进行系统的多学科随访直至成年。