Zani Augusto, Wolinska Justyna, Cobellis Giovanni, Chiu Priscilla P L, Pierro Agostino
Division of General and Thoracic Surgery, Physiology and Experimental Medicine Program, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada.
Pediatr Surg Int. 2016 Jan;32(1):83-8. doi: 10.1007/s00383-015-3816-7. Epub 2015 Oct 30.
To review the outcomes of extremely low birth weight (ELBW, <1000 g) infants with esophageal atresia/tracheoesophageal fistula (EA/TEF).
Health records of ELBW EA/TEF infants treated at our institution from 2000 to 2014 were reviewed (REB1000046653). Demographics, operative approach and postoperative complications were analyzed. Data are reported as median (range).
Of 268 EA/TEF infants, 8 (3 %, five females) were ELBW (930 g, 540-995). Gestational age was 28 weeks (23-32). Seven had type-C EA/TEF and one type B.
One trisomy 18 infant received no treatment and died; one initially diagnosed as type A had primary repair at 126 days of life (DOL); six underwent TEF ligation (three trans-pleural) with primary repair in one and delayed anastomosis in two (DOL 120 and 178). The remaining three died (gastrostomy dehiscence and peritonitis, liver hemorrhage during peritoneal drain insertion, severe chronic lung disease and brain hemorrhages). At a median follow-up of 3 years (range 15 months-5 years), all survivors are thriving.
ELBW infants with EA/TEF are rare and result in high morbidity and mortality. Mortality is mainly related to complications not associated with EA/TEF repair. Fistula ligation followed by delayed anastomosis seems to achieve a better outcome in ELBW infants.
回顾极低出生体重（ELBW，<1000克）食管闭锁/气管食管瘘（EA/TEF）婴儿的治疗结果。
回顾了2000年至2014年在我院接受治疗的ELBW EA/TEF婴儿的健康记录（REB1000046653）。分析了人口统计学、手术方式和术后并发症。数据以中位数（范围）报告。
在268例EA/TEF婴儿中，8例（3%，5例女性）为ELBW（930克，540 - 995克）。胎龄为28周（23 - 32周）。7例为C型EA/TEF，1例为B型。
1例18三体婴儿未接受治疗死亡；1例最初诊断为A型的婴儿在出生后126天（DOL）进行了一期修复；6例进行了TEF结扎（3例经胸膜），其中1例进行了一期修复，2例延迟吻合（DOL 120和178）。其余3例死亡（胃造口裂开和腹膜炎、腹腔引流管插入时肝出血、严重慢性肺病和脑出血）。中位随访3年（范围15个月 - 5年），所有幸存者均发育良好。
ELBW EA/TEF婴儿罕见，发病率和死亡率高。死亡率主要与EA/TEF修复无关的并发症有关。对于ELBW婴儿，先进行瘘管结扎再延迟吻合似乎能取得更好的治疗效果。
