Surgical Department A, Odense University Hospital, Denmark.
J Pediatr Surg. 2013 Oct;48(10):2032-5. doi: 10.1016/j.jpedsurg.2013.03.062.
BACKGROUND/PURPOSE: Surgical treatment of long-gap esophageal atresia (LGEA) is challenging. Methods which facilitate stretching of the esophageal pouches may allow primary anastomosis. Botulinum toxin type A (BTX-A) blocks acetylcholine release in neuromuscular junctions, thereby causing muscle relaxation. We hypothesized that intramural injections with BTX-A into the esophageal wall of piglets would significantly elongate the tissue upon stretch.
Twenty-four piglets were randomized to receive BTX-A of placebo (saline). After one hour, the esophagus was removed en bloc and tested in a stretch-tension device.
The mean esophageal elongation was 84% (range 83-101) in the BTX-A-group and 65% (50-78) in the control group. The mean difference between the two groups was 18%, which was significant (p < 0.001).
Intramural injections with botulinum toxin type A elongate the esophagus significantly. Clinically, this could be a potential method to achieve primary anastomosis in LGEA. Additional clinical studies are necessary to evaluate the method before it can be generally recommended.
背景/目的：长段食管闭锁（LGEA）的手术治疗具有挑战性。有助于伸展食管囊的方法可以允许进行一期吻合。肉毒毒素 A 型（BTX-A）阻断神经肌肉接头处乙酰胆碱的释放，从而导致肌肉松弛。我们假设向小猪的食管壁内注射 BTX-A 会在拉伸时显著延长组织。
24 头小猪随机接受 BTX-A 或安慰剂（生理盐水）注射。1 小时后，整块取出食管并在拉伸张力装置中进行测试。
BTX-A 组的平均食管伸长率为 84%（范围 83-101），对照组为 65%（50-78）。两组之间的平均差异为 18%，差异具有统计学意义（p < 0.001）。
向食管壁内注射肉毒毒素 A 可显著延长食管。临床上，这可能是实现 LGEA 一期吻合的一种潜在方法。在广泛推荐该方法之前，需要进行更多的临床研究来评估该方法。
