Stolar C J, Levy J P, Dillon P W, Reyes C, Belamarich P, Berdon W E
Division of Pediatric Surgery, Babies Hospital, Columbia-Presbyterian Medical Center, New York, New York 10032.
Am J Surg. 1990 Feb;159(2):204-7. doi: 10.1016/s0002-9610(05)80261-2.
As more infants with congenital diaphragmatic hernia (CDH) survive by means of extracorporeal membrane oxygenation (ECMO), new clinical observations are being made. We report anatomic and functional abnormalities of the esophagus in these infants. Twenty-two of 30 infants with CDH survived. Three of 7 non-ECMO-treated infants and 14 of 17 ECMO-treated infants had an air- or fluid-filled mediastinal mass that was confirmed by an upper gastrointestinal series as ectatic esophagus. Contrast studies demonstrated severe gastroesophageal reflux. Intra-esophageal pH monitoring confirmed significant reflux (Euler scores greater than 50) in 69% of tested patients. Prolonged acid clearance in most patients implied abnormal peristalsis. Hydramnios was correlated to the observed esophageal abnormalities, being present in 13 of 16 infants with an available amniotic history. All patients had symptomatic gastroesophageal reflux managed without antireflux surgery and were discharged 36 +/- 2 days after initiation of feeding. Follow-up (range: 7 to 56 months; mean: 32 months) showed that weight gain in affected children was slower than in those not affected. All but one are asymptomatic. Repeat upper gastrointestinal series shows persistent ectasia but less gastro-esophageal reflux. Gastroesophageal reflux/ectasia is a new observation with CDH. The associated hydramnios may result from proximal foregut obstruction by kinking the gastroesophageal junction with CDH. The radiographic appearance can be quite unusual. Clinical manifestations of gastro-esophageal reflux are manageable without surgery but may account for the observed compromised growth.
随着越来越多的先天性膈疝（CDH）婴儿通过体外膜肺氧合（ECMO）存活下来，新的临床观察结果不断涌现。我们报告了这些婴儿食管的解剖和功能异常情况。30例CDH婴儿中有22例存活。7例未接受ECMO治疗的婴儿中有3例，17例接受ECMO治疗的婴儿中有14例出现了气液填充的纵隔肿块，上消化道造影证实为食管扩张。对比研究显示存在严重的胃食管反流。食管内pH监测证实69%的受试患者存在显著反流（欧拉评分大于50）。大多数患者的酸清除时间延长提示蠕动异常。羊水过多与观察到的食管异常相关，在16例有羊水病史的婴儿中有13例存在羊水过多。所有患者的症状性胃食管反流均未通过抗反流手术进行处理，在开始喂养后36±2天出院。随访（范围：7至56个月；平均：32个月）显示，患病儿童的体重增长比未患病儿童慢。除1例患者外，其余均无症状。重复上消化道造影显示食管持续扩张，但胃食管反流减轻。胃食管反流/扩张是CDH的一项新观察结果。相关的羊水过多可能是由于CDH导致胃食管交界处扭结，引起前肠近端梗阻所致。影像学表现可能非常不寻常。胃食管反流的临床表现无需手术即可控制，但可能是观察到的生长发育受限的原因。
