Department of Pediatric Surgery, La Paz University Hospital, Autonomous University of Madrid, 28046 Madrid, Spain.
Dis Esophagus. 2013 May-Jun;26(4):401-4. doi: 10.1111/dote.12063.
Gastroesophageal reflux (GER) is almost constant in esophageal atresia and tracheoesophageal fistula (EA/TEF). These patients resist medical treatment and require antireflux surgery quite often. The present review examines why this happens, the long-term consequences of GER and the main indications and results of fundoplication in this particular group of patients. The esophagus of EA/TEF patients is malformed and has abnormal extrinsic and intrinsic innervation and, consequently, deficient sphincter function and dysmotility. These anomalies are permanent. Fifty percent of patients overall have GER, and one-fifth have Barrett's metaplasia. Close to 100%, GER of pure and long-gap cases require fundoplication. In the long run, these patients have 50-fold higher risk of carcinoma than the control population. GER in EA/TEF does not respond well to dietary, antacid, or prokinetic medication. Surgery is necessary in protracted anastomotic stenoses, in pure and long-gap cases, and when there is an associated duodenal atresia. It should be indicated as well in other symptomatic cases when conservative treatment fails. However, confection of a suitable wrap is anatomically difficult in this condition as shown by a failure rate of 30% that is also explained by the persistence for life of the conditions facilitating GER.
胃食管反流（GER）在食管闭锁和气管食管瘘（EA/TEF）中几乎是持续存在的。这些患者对药物治疗有抵抗力，并且经常需要抗反流手术。本综述探讨了为什么会发生这种情况，GER 的长期后果，以及在这一特殊患者群体中胃底折叠术的主要适应证和结果。EA/TEF 患者的食管畸形，存在异常的外在和内在神经支配，因此括约肌功能和动力不足。这些异常是永久性的。总体而言，50%的患者存在 GER，1/5的患者存在 Barrett 化生。几乎 100%的单纯性和长间隙病例的 GER 需要进行胃底折叠术。从长远来看，这些患者患癌的风险比对照组高 50 倍。EA/TEF 中的 GER 对饮食、抗酸剂或促动力药物治疗反应不佳。在迁延性吻合口狭窄、单纯性和长间隙病例以及存在十二指肠闭锁时需要手术。在保守治疗失败的其他有症状的情况下，也应考虑手术。然而，如 30%的失败率所表明的那样，由于促进 GER 的条件终生存在，这种情况下制作合适的包裹物在解剖上具有难度。
