食管闭锁管理的国际调查

International survey on the management of esophageal atresia.

作者信息

Zani Augusto, Eaton Simon, Hoellwarth Michael E, Puri Prem, Tovar Juan, Fasching Guenter, Bagolan Pietro, Lukac Marija, Wijnen Rene, Kuebler Joachim F, Cecchetto Giovanni, Rintala Risto, Pierro Agostino

机构信息

Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom.

Department of Pediatric and Adolescents Surgery, Medical University of Graz, Graz, Austria.

出版信息

Eur J Pediatr Surg. 2014 Feb;24(1):3-8. doi: 10.1055/s-0033-1350058. Epub 2013 Aug 9.

DOI:10.1055/s-0033-1350058

PMID:23934626

Abstract

INTRODUCTION

Because many aspects of the management of esophageal atresia (EA) are still controversial, we evaluated the practice patterns of this condition across Europe.

METHODS

A survey was completed by 178 delegates (from 45 [27 European] countries; 88% senior respondents) at the EUPSA-BAPS 2012.

RESULTS

Approximately 66% of respondents work in centers where more than five EA repairs are performed per year. Preoperatively, 81% of respondents request an echocardiogram, and only 43% of respondents routinely perform preoperative bronchoscopy. Approximately 94% of respondents prefer an open approach, which is extrapleural in 71% of respondents. There were no differences in use of thoracoscopy between Europeans (10%) and non-Europeans (11%, p = nonsignificant). Approximately 60% of respondents measure the gap intraoperatively. A transanastomotic tube (90%) and chest drain (69%) are left in situ. Elective paralysis is adopted by 56% of respondents mainly for anastomosis tension (65%). About 72% of respondents routinely request a contrast study on postoperative day 7 (2-14). Approximately 54% of respondents use parenteral nutrition, 40% of respondents start transanastomotic feeds on postoperative day 1, and 89% of respondents start oral feeds after postoperative day 5. Pure EA: 46% of respondents work in centers that repair two or more than two pure EA a year. About 60% of respondents opt for delayed primary anastomosis at 3 months (1-12 months) with gastrostomy formation without esophagostomy. Anastomosis is achieved with open approach by 85% of respondents. About 47% of respondents attempt elongation of esophageal ends via Foker technique (43%) or with serial dilations with bougies (41%). Approximately 67% of respondents always attempt an anastomosis. Gastric interposition is the commonest esophageal substitution.

CONCLUSION

Many aspects of EA management are lacking consensus. Minimally invasive repair is still sporadic. We recommend establishment of an EA registry.

摘要

引言

由于食管闭锁（EA）管理的许多方面仍存在争议，我们评估了欧洲各地对这种疾病的治疗模式。

方法

178名代表（来自45个[27个欧洲]国家；88%为高级受访者）在2012年欧洲小儿外科医师协会-英国小儿外科学会会议上完成了一项调查。

结果

约66%的受访者所在中心每年进行超过5例EA修复手术。术前，81%的受访者要求进行超声心动图检查，只有43%的受访者常规进行术前支气管镜检查。约94%的受访者倾向于开放手术，其中71%采用胸膜外入路。欧洲人（10%）和非欧洲人（11%，p=无统计学意义）在胸腔镜使用方面无差异。约60%的受访者术中测量间隙。留置经吻合口管（90%）和胸腔引流管（69%）。56%的受访者采用选择性麻痹，主要用于缓解吻合口张力（65%）。约72%的受访者常规在术后第7天（2-14天）要求进行造影检查。约54%的受访者使用肠外营养，40%的受访者在术后第1天开始经吻合口喂养，89%的受访者在术后第5天之后开始经口喂养。单纯EA：46%的受访者所在中心每年修复两例或两例以上单纯EA。约60%的受访者选择在3个月（1-12个月）进行延迟一期吻合，并形成胃造口而不做食管造口。85%的受访者通过开放手术完成吻合。约47%的受访者尝试通过福克技术（43%）或使用探条进行系列扩张（41%）来延长食管末端。约67%的受访者总是尝试进行吻合。胃代食管是最常见的食管替代方法。