Department of Pediatric Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain.
J Pediatr Surg. 2010 Feb;45(2):341-5. doi: 10.1016/j.jpedsurg.2009.10.065.
Gastric pull-up has become the predominant technique for esophageal replacement because of allegedly deficient results of colon grafts. This retrospective study examines the long-term results in a large series of colonic interpositions.
One hundred six children (median, 2.9 years; range, 0.32-15 years) had their esophagus replaced between 1965 and 2008, of which 96 had colon grafts. Those survivors who were 18 years and older were contacted and, if willing, interviewed, examined, and had their functional ability rated using the Karnofsky index.
Ninety-six children had undergone a colon graft, and of these, 9 (9.3%) died. There were 65 long-term survivors whose indications for surgery included caustic injury (n = 32), failed tracheoesophageal fistula repair (n = 16), pure esophageal atresia (n = 14), and others (n = 3). The graft was either retrosternal (n = 49) or mediastinal (n = 16 patients). Twelve patients were unavailable for long-term assessment. After a median follow-up of 33.3 (11-41) years, 23 (43%) of 53 individuals experienced mild symptoms of reflux; scoliosis, 12 (22%) of 53, and/or other complications, 15 (27%) of 53 required further surgery. Thirty-two patients (60%) with Karnofsky indexes of 80% or higher felt healthy, 19 (36%) had mild life-style limitations (index, 40%-80%), and 2 had indexes less than 40%. Most patients live normal lives.
Colon conduits restored gastrointestinal continuity with limited mortality and considerable morbidity but good functional outcome and health perception in the long-term. Our study suggests that colon grafts are no worse than gastric pull-ups in the long-term.
由于结肠移植物的结果据称存在缺陷，胃上提已成为食管替代的主要技术。这项回顾性研究检查了大量结肠间置术的长期结果。
1965 年至 2008 年间，有 106 名儿童（中位数为 2.9 岁；范围为 0.32-15 岁）接受了食管替代手术，其中 96 名接受了结肠移植物。那些年满 18 岁的幸存者被联系，如果愿意，接受采访、检查，并使用卡诺夫斯基指数评估他们的功能能力。
96 名儿童接受了结肠移植物，其中 9 名（9.3%）死亡。有 65 名长期幸存者，他们的手术指征包括腐蚀性损伤（n=32）、气管食管瘘修复失败（n=16）、单纯性食管闭锁（n=14）和其他原因（n=3）。移植物位于胸骨后（n=49）或纵隔（n=16 例）。12 名患者无法进行长期评估。在中位数为 33.3（11-41）年的随访后，53 名个体中有 23 名（43%）出现轻度反流症状；53 名中有 12 名（22%）患有脊柱侧凸，53 名中有 15 名（27%）需要进一步手术。32 名（60%）卡诺夫斯基指数为 80%或更高的患者感觉健康，19 名（36%）生活方式轻度受限（指数为 40%-80%），2 名指数低于 40%。大多数患者过着正常的生活。
结肠导管恢复了胃肠道连续性，死亡率有限，发病率较高，但长期功能结果和健康感知良好。我们的研究表明，在长期内，结肠移植物并不比胃上提术差。
