García Martínez L, Molino Gahete J A, Redecillas Ferreiro S, Bordón Cabrera E, Bueno Recio J, Guillén Burrieza G, Giné Prades C, Lara Valtueña A, Lloret Roca J
Cirugía Neonatal y Fetal. Hospital Universitario Vall d'Hebron. Barcelona.
Gastroenterología Pediátrica. Hospital Universitario Vall d'Hebron. Barcelona.
Cir Pediatr. 2016 Jan 25;29(1):15-18.
Esophageal replacement is a surgical alternative once native esophagus can't be preserved. Different organs and routes for the replacement have been described, being the retroesternal route the least used. The aim is to present our results using gastric tube esophagoplasty with a retroesternal approach.
We performed a retrospective and descriptive study of 11 patients operated from 2000 to 2015. Median age at surgery was 2.2 years (5 months-9 years) and median weight was 11.2 kg (7.8-21). A gastric tube esophagoplasty using the retroesternal route, forced pyloric dilatation and end-to-side esophago-gastric cervical anastomosis were performed.
Ten esophagus replacements had long-gap esophageal atresia and one, severe esophagus caustication secondary to button battery ingestion. No intraoperatory complications were observed. Three patients developed anastomosis leak. Two cases developed anastomotic stenosis managed with endoscopic dilatation in 2 and 4 occasions, respectively. Four patients showed occasional dumping syndrome and are asymptomatic after medical treatment. With a median follow up of 6.3 years (0.2-14.8), all our patients are alive and complete oral diet has been established in all of them.
Gastric tube esophagoplasty using the retroesternal route is a suitable technique in order to reestablish gastrointestinal continuity once native esophagus can't be preserved. In our experience is a safe option, related to few complications.
一旦无法保留原生食管，食管置换是一种手术选择。已经描述了不同的用于置换的器官和途径，胸骨后途径是使用最少的。目的是展示我们采用胸骨后途径的胃管食管成形术的结果。
我们对2000年至2015年接受手术的11例患者进行了回顾性描述性研究。手术时的中位年龄为2.2岁（5个月至9岁），中位体重为11.2千克（7.8至21千克）。采用胸骨后途径进行胃管食管成形术、强制幽门扩张以及食管胃颈部端侧吻合术。
10例食管置换患者患有长间隙食管闭锁，1例因吞食纽扣电池导致严重食管腐蚀。未观察到术中并发症。3例患者发生吻合口漏。2例患者发生吻合口狭窄，分别在内镜下扩张2次和4次后得到处理。4例患者偶尔出现倾倒综合征，经药物治疗后无症状。中位随访时间为6.3年（0.2至14.8年），所有患者均存活，且全部能够正常经口饮食。
一旦无法保留原生食管，采用胸骨后途径的胃管食管成形术是重建胃肠道连续性的一种合适技术。根据我们的经验，这是一种安全的选择，并发症较少。
