Schneider Anne, Gottrand Frédéric, Sfeir Rony, Duhamel Alain, Bonnevalle Michel, Guimber Dominique, Michaud Laurent
Department of Pediatric Surgery, University Hospital of Strasbourg, Strasbourg, France.
Eur J Pediatr Surg. 2012 Oct;22(5):399-403. doi: 10.1055/s-0032-1315807. Epub 2012 Jul 7.
The purpose of this study is to study the frequency and factors associated with lower esophageal dilation (LED) after Nissen fundoplication.
This retrospective monocentric study included 288 patients who had undergone Nissen fundoplication from 1998 to 2009. The frequency of children requiring LED was assessed. The clinical characteristics of the patients at the time of fundoplication, their symptoms, and outcomes were recorded. The population with LED (group 1) was compared with the population without LED (group 2) to identify factors associated with postfundoplication LED using multivariate analysis.
LED was required by 70 patients (24%) because of postoperative dysphagia, and 45/70 were dilated within the first 6 months. The mean age at dilation was 72 months (standard deviation [SD] 65), with an average post-Nissen delay of 9 months (SD 13). Surgical revision was required by 11 patients because of LED failure (n = 10) or postdilation perforation (n = 1). Patients who required post-Nissen dilation were significantly more frequently fed orally than those in group 2 and had more postoperative complications (dumping syndrome, surgical revision).
A significant frequency of postfundoplication LED was observed in this pediatric population. Dilation was associated in children with preoperative feeding or postoperative complications (dumping syndrome, surgical revision).
本研究旨在探讨nissen胃底折叠术后食管下段扩张（LED）的发生率及相关因素。
这项回顾性单中心研究纳入了1998年至2009年期间接受nissen胃底折叠术的288例患者。评估了需要进行LED的儿童的发生率。记录了患者在胃底折叠术时的临床特征、症状和结局。将发生LED的患者群体（第1组）与未发生LED的患者群体（第2组）进行比较，采用多变量分析确定胃底折叠术后LED的相关因素。
70例患者（24%）因术后吞咽困难需要进行LED，其中45/70例在术后6个月内进行了扩张。扩张时的平均年龄为72个月（标准差[SD]65），nissen术后平均延迟时间为9个月（SD 13）。11例患者因LED失败（n = 10）或扩张后穿孔（n = 1）需要进行手术修正。与第2组相比，nissen术后需要扩张的患者经口喂养的频率明显更高，术后并发症（倾倒综合征、手术修正）更多。
在这一儿科人群中观察到胃底折叠术后LED的发生率较高。扩张与儿童术前喂养或术后并发症（倾倒综合征、手术修正）有关。
