Garrett Deiadra, Anselmo Dean, Ford Henri, Ndiforchu Fombe, Nguyen Nam
Department of Pediatric Surgery, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
Pediatr Surg Int. 2011 Jul;27(7):737-42. doi: 10.1007/s00383-011-2862-z. Epub 2011 Feb 25.
Minimally invasive esophagectomy and gastric pull-up is a widely accepted method in adults. However, the experience in the pediatric population is limited. Minimally invasive esophagectomy represents a new alternative technique to the conventional open approach. We wish to report our small case series of minimally invasive esophagectomy and gastric pull-up in pediatric patients. The aim of the study is to evaluate the feasibility, safety, and outcomes of the procedure.
Three patients (2 girls and 1 boy) with average age 46 months (34-57 months) and average weight 12.6 kg (11-15 kg) underwent the procedure. The indications for esophagectomy were esophageal stricture from caustic ingestion (2 patients) and failed repair of esophageal atresia (1 patient).
Average operative time was 7 h (0519-0752 hours). There were no intraoperative complications with the average blood loss of 50 cc (5-125 cc). No anastomotic leaks were noted on the initial esophagrams that were obtained on postoperative day five or six. One patient developed a cervical wound infection on postoperative day seven due to a retained piece of Penrose, which required a neck exploration, removal of foreign body and repair of a small leak. One patient developed an anastomotic stricture at the 7-month follow-up. She was successfully treated with two balloon dilatations. One patient developed a delayed esophagogastric anastomotic leak at 3 months. The leak spontaneously closed after surgical drainage. At average of 22-month follow-up (15-36 months), all patients were eating regular food with excellent weight gain.
Minimally invasive esophagectomy and gastric pull-up is technically challenging but feasible and safe with acceptable outcomes. However, further study is needed to further validate the approach.
微创食管切除术及胃上提术在成人中是一种广泛接受的方法。然而，在儿科患者中的经验有限。微创食管切除术是传统开放手术方法之外的一种新的替代技术。我们希望报告我们在儿科患者中进行微创食管切除术及胃上提术的小病例系列。本研究的目的是评估该手术的可行性、安全性及结果。
3例患者（2例女孩和1例男孩），平均年龄46个月（34 - 57个月），平均体重12.6千克（11 - 15千克）接受了该手术。食管切除术的指征为腐蚀性摄入导致的食管狭窄（2例患者）和食管闭锁修复失败（1例患者）。
平均手术时间为7小时（05:19 - 07:52）。术中无并发症，平均失血量为50毫升（5 - 125毫升）。术后第5或6天进行的初次食管造影未发现吻合口漏。1例患者在术后第7天因残留一块橡皮引流条发生颈部伤口感染，需要进行颈部探查、取出异物并修复一个小漏口。1例患者在7个月随访时出现吻合口狭窄。她通过两次球囊扩张成功治愈。1例患者在3个月时出现延迟性食管胃吻合口漏。经手术引流后漏口自行闭合。平均22个月随访（15 - 36个月）时，所有患者均正常进食，体重增加良好。
微创食管切除术及胃上提术在技术上具有挑战性，但可行且安全，结果可接受。然而，需要进一步研究以进一步验证该方法。
