Lepeytre C, De Lagausie P, Merrot T, Baumstarck K, Oudyi M, Dubus J-C
Unité de pneumologie pédiatrique, Assistance publique-hôpitaux de Marseille, CHU de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
Arch Pediatr. 2013 Oct;20(10):1096-104. doi: 10.1016/j.arcped.2013.06.035. Epub 2013 Aug 7.
The aim of this study was to evaluate the medium-term outcome (health status, medical and surgical French National Health Authority-recommended follow-up, and quality of life) of children born with type III esophageal atresia (EA). Previous events (during the perinatal period, associated abnormalities, respiratory and digestive complications) of children treated for type III EA at the Marseille university hospitals between 1999 and 2009 were noted. Parents completed a standardized questionnaire concerning the health of their children during the previous year, and a quality-of-life questionnaire (PedsQL 4.0) was also completed by children aged more than 8 years. Among the 68 children treated, 44 responded to our solicitation (mean age, 7.6 years; range, 3-12.8 years). Previous important events were : pneumonia(s) (65%), asthma before the age of 3 years (66%), hospitalization for a respiratory event (45%), fundoplication (20%), and esophageal dilatation (45%). We noted current chronic cough (16%), asthma (30%), dysphagia (39%), and symptomatic gastroesophageal reflux (9%). National guidelines were not respected, except for the surgical indications in children aged less than 6 years. The quality-of-life scores (n=43 children) were similar to healthy controls but were negatively influenced by a gastrostomy procedure (P=0.020), pneumonia (P=0.013), and hospitalization due to a respiratory event (P=0.006) or a digestive event (P=0.010), and also by current asthma (P=0.004). In conclusion, despite recurrent respiratory or digestive symptoms and inadequate recommended follow-up, the quality of life of children treated for type III of EA is good.
本研究旨在评估Ⅲ型食管闭锁(EA)患儿的中期预后(健康状况、法国国家卫生管理局推荐的医学及外科随访情况和生活质量)。记录了1999年至2009年在马赛大学医院接受Ⅲ型EA治疗患儿的既往情况(围产期、相关畸形、呼吸和消化并发症)。家长填写了一份关于其子女上一年健康状况的标准化问卷,8岁以上儿童还完成了一份生活质量问卷(儿童生活质量量表4.0版)。在接受治疗的68名儿童中,44名回应了我们的邀请(平均年龄7.6岁;范围3 - 12.8岁)。既往重要事件包括:肺炎(65%)、3岁前哮喘(66%)、因呼吸事件住院(45%)、胃底折叠术(20%)和食管扩张(45%)。我们注意到目前存在慢性咳嗽(16%)、哮喘(30%)、吞咽困难(39%)和有症状的胃食管反流(9%)。除了6岁以下儿童的手术指征外,未遵循国家指南。生活质量评分(n = 43名儿童)与健康对照组相似,但受胃造口术(P = 0.020)、肺炎(P = 0.013)、因呼吸事件(P = 0.006)或消化事件住院(P = 0.010)以及目前的哮喘(P = 0.004)的负面影响。总之,尽管存在反复的呼吸或消化症状以及推荐随访不足的情况,但接受Ⅲ型EA治疗的儿童生活质量良好。