Chang Eun Young, Chang Hye Kyung, Han Seok Joo, Choi Seung Hoon, Hwang Eui Ho, Oh Jung-Tak
Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Korean Surg Soc. 2012 Jul;83(1):43-9. doi: 10.4174/jkss.2012.83.1.43. Epub 2012 Jun 26.
Treatment for esophageal atresia has advanced over several decades due to improvements in surgical techniques and neonatal intensive care. Subsequent to increased survival, postoperative morbidity has become an important issue in this disease. The aim of our study was to analyze our experience regarding the treatment of esophageal atresia.
We reviewed and analyzed the clinical data of patients who underwent surgery for esophageal atresia at Severance Children's Hospital from 1995 to 2010 regarding demographics, surgical procedures, and postoperative outcomes.
Seventy-two patients had surgery for esophageal atresia. The most common gross type was C (81.9%), followed by type A (15.3%). Primary repair was performed in 52 patients. Staged operation was performed in 17 patients. Postoperative esophageal strictures developed in 43.1% of patients. Anastomotic leakages occurred in 23.6% of patients, and recurrence of tracheoesophageal fistula was reported in 8.3% of patients. Esophageal stricture was significantly associated with long-gap (≥3 cm or three vertebral bodies) atresia (P = 0.042). The overall mortality rate was 15.3%. The mortality in patients weighing less than 2.5 kg was higher than in patients weighing at least 2.5 kg (P = 0.001). During the later period of this study, anastomotic leakage and mortality both significantly decreased compared to the earlier study period (P = 0.009 and 0.023, respectively).
The survival of patients with esophageal atresia has improved over the years and the rate of anastomotic leakage has been significantly reduced. However, overall morbidities related to surgical treatment of esophageal atresia still exists with high incidence.
由于手术技术和新生儿重症监护的改进，食管闭锁的治疗在过去几十年中取得了进展。随着生存率的提高，术后发病率已成为该疾病的一个重要问题。我们研究的目的是分析我们在食管闭锁治疗方面的经验。
我们回顾并分析了1995年至2010年在Severance儿童医院接受食管闭锁手术患者的临床资料，包括人口统计学、手术过程和术后结果。
72例患者接受了食管闭锁手术。最常见的大体类型是C型（81.9%），其次是A型（15.3%）。52例患者进行了一期修复。17例患者进行了分期手术。43.1%的患者术后出现食管狭窄。23.6%的患者发生吻合口漏，8.3%的患者报告气管食管瘘复发。食管狭窄与长节段（≥3 cm或三个椎体）闭锁显著相关（P = 0.042）。总死亡率为15.3%。体重小于2.5 kg的患者死亡率高于体重至少2.5 kg的患者（P = 0.001）。在本研究的后期，与早期研究阶段相比，吻合口漏和死亡率均显著降低（分别为P = 0.009和0.023）。
多年来，食管闭锁患者的生存率有所提高，吻合口漏的发生率也显著降低。然而，与食管闭锁手术治疗相关的总体发病率仍然很高。
