Estevão-Costa José, Fragoso Ana Catarina, Campos Miguel, Trindade Eunice, Amil-Dias Jorge
Serviço de Cirurgia Pediátrica, Faculdade de Medicina, Universidade do Porto e Hospital S João EPE, Porto, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 2:107-12. Epub 2011 Dec 31.
BACKGROUND & PURPOSE: Despite potential advantages of gastric transposition there are some concerns about this surgical technique of esophageal substitution in children. In the current study the morbidity and functional outcome are surveyed in a series of patients undergoing gastric transposition due to extensive post-corrosive esophageal strictures.
Retrospective analysis of children proposed for esophageal replacement from September 2003 through April 2007 after endoscopic dilations failure. Demographic and pathological features, intra and postoperative complications and clinical outcome were assessed. Continuous variables are expressed as median [range].
There were six children (age: 4.3 [2.5;14.4] years) with esophageal structures secondary to corrosive alkali ingestion; five had been submitted to dilation (n = 8 [7;27]) and one had undergone gastrostomy. Esophagectomy without thoracotomy plus gastric transposition were uneventfully performed in all cases. There was no mortality. On postoperative course there was one hypertensive pneumothorax and one pneumonia. With a follow-up of 50 [38;80] months, two children experienced mild dysphagia that was promptly solved by one or two sessions of dilations of esophagogastric anastomosis; both weight and height were between 5th and 75th centiles; none presented gastrointestinal or recurrent respiratory symptoms, anemia or substitute dilation. CONCLUSION. Transhiatal esophagectomy with gastric transposition in posterior mediastinum presented low morbidity and excellent functional outcome with no impairment of growth or respiratory function, at least on short/medium term.
尽管胃转位术有潜在优势，但对于儿童食管替代的这种手术技术仍存在一些担忧。在本研究中，我们对一系列因广泛腐蚀性食管狭窄而接受胃转位术的患者的发病率和功能结局进行了调查。
对2003年9月至2007年4月内镜扩张失败后拟行食管置换的儿童进行回顾性分析。评估人口统计学和病理学特征、术中及术后并发症以及临床结局。连续变量以中位数[范围]表示。
有6名儿童（年龄：4.3[2.5；14.4]岁）因腐蚀性碱摄入导致食管结构异常；5名儿童接受了扩张治疗（n = 8[7；27]），1名儿童接受了胃造口术。所有病例均顺利进行了不开胸食管切除术加胃转位术。无死亡病例。术后过程中出现1例高血压性气胸和1例肺炎。随访50[38；80]个月，2名儿童出现轻度吞咽困难，通过一两次食管胃吻合口扩张迅速解决；体重和身高均在第5至第75百分位数之间；均未出现胃肠道或反复呼吸道症状、贫血或替代扩张。结论。经裂孔食管切除术加后纵隔胃转位术的发病率低，功能结局良好，至少在短期/中期对生长或呼吸功能无损害。
