Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, People's Republic of China.
J Pediatr Surg. 2011 Dec;46(12):2274-8. doi: 10.1016/j.jpedsurg.2011.09.011.
The aim of this study was to evaluate the clinical outcome of conservative management of anastomotic leakage (AL) after surgical repair for esophageal atresia.
Data from 85 neonates with esophageal atresia who underwent surgical correction were retrospectively analyzed. Conservative treatment had been adopted for AL. The incidence and severity of postoperative AL as well as its effects were analyzed.
Among the 85 neonates, postoperative AL occurred in 21 (25%) cases, with major leaks in 15 cases and minor leaks in 6. The stricture index of the 21 neonates with AL (0.615 ± 0.032) was significantly different (P = .008) from that of the 64 neonates without leakage (0.509 ± 0.018). The overall incidence of gastroesophageal reflux (GER) was 36%. Esophageal dysmotility and clinically significant tracheomalacia were observed in 69 and 7 infants, respectively, of the 80 surviving patients. The incidence of GER, dysmotility, and tracheomalacia in patients with or without AL was similar. The severity of GER in patients with different numbers of sessions of dilation was significantly different (P = .0015).
Postoperative esophageal AL is effectively treatable by conservative methods in most neonates. The occurrence of AL may aggravate the severity of esophageal stricture but does not affect the incidence of GER, esophageal dysmotility, and tracheomalacia.
本研究旨在评估食管闭锁修复术后吻合口漏（AL）的保守治疗临床结局。
回顾性分析 85 例接受食管闭锁手术矫正的新生儿数据。对 AL 采用了保守治疗。分析了术后 AL 的发生率和严重程度及其影响。
85 例新生儿中，术后发生 AL21 例（25%），其中重度漏 15 例，轻度漏 6 例。AL 新生儿的狭窄指数（0.615±0.032）与无漏新生儿（0.509±0.018）差异有统计学意义（P=0.008）。80 例存活患儿中整体胃食管反流（GER）发生率为 36%。食管动力障碍和有临床意义的气管软化分别见于 69 和 7 例患儿。有或无 AL 的患儿 GER、动力障碍和气管软化的发生率相似。不同扩张次数患儿 GER 的严重程度差异有统计学意义（P=0.0015）。
大多数新生儿可通过保守方法有效治疗术后食管 AL。AL 的发生可能加重食管狭窄的严重程度，但不影响 GER、食管动力障碍和气管软化的发生率。
