Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka 594-1101, Japan.
J Pediatr Surg. 2009 Dec;44(12):2282-6. doi: 10.1016/j.jpedsurg.2009.07.049.
BACKGROUND/PURPOSE: Thoracoscopic repair has recently been attempted in newborns with esophageal atresia (EA), but it remains unclear whether thoracoscopic dissection reduces pathological gastroesophageal reflux. We investigated the influence of a thoracoscopic approach on esophageal motor function in patients with EA.
Clinical and gastrointestinal data of 10 patients with EA with open repair (group A) and 7 with thoracoscopic repair (group B) were analyzed retrospectively. Videomanometry was conducted to investigate esophageal motor patterns. Esophageal acid exposure was evaluated with 24-hour esophageal pH monitoring. Data are expressed as medians and ranges.
Contractions in the distal esophagus were conspicuously absent in 1 and 3 patients in groups A and B, respectively (P = .26). There were no significant differences in esophageal acid exposure (5.5% [0.7%-24.6%] vs 3.7% [0.3%-56.8%]; P = .71) or mean esophageal acid reflux time (0.5 minutes [0.1-1.4 minutes] vs 0.5 minutes [0.1-1.3 minutes]; P = .87) between the 2 groups. Fundoplication was conducted in 2 patients in each group (P = .60), all of whom had conspicuously absent distal esophageal contractions. Those contractions were preserved in the remaining patients with the exception of 1 group B patient.
There are unlikely to be benefits from thoracoscopic repair of EA in terms of postoperative esophageal motor function.
背景/目的：胸腔镜修复术最近已尝试应用于食管闭锁（EA）的新生儿，但胸腔镜下解剖是否能减少病理性胃食管反流仍不清楚。我们研究了胸腔镜入路对 EA 患者食管运动功能的影响。
回顾性分析 10 例行开放修复术（A 组）和 7 例行胸腔镜修复术（B 组）的 EA 患者的临床和胃肠道数据。通过测压法研究食管运动模式。通过 24 小时食管 pH 监测评估食管酸暴露。数据以中位数和范围表示。
A 组和 B 组各有 1 例和 3 例患者远端食管收缩明显缺失（P =.26）。两组食管酸暴露（5.5%[0.7%-24.6%] vs 3.7%[0.3%-56.8%]；P =.71）或平均食管酸反流时间（0.5 分钟[0.1-1.4 分钟] vs 0.5 分钟[0.1-1.3 分钟]；P =.87）无显著差异。两组均有 2 例行胃底折叠术（P =.60），所有患者均有明显的远端食管收缩缺失。除 1 例 B 组患者外，其余患者均保留了这些收缩。
胸腔镜修复 EA 在术后食管运动功能方面可能没有获益。
