Okuyama Hiroomi, Tazuke Yuko, Uenoa Takehisa, Yamanaka Hiroaki, Takama Yuichi, Saka Ryuta, Nara Keigo, Usui Noriaki
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodocho, Izumi, Osaka, 594-1101, Japan.
Surg Today. 2017 Jul;47(7):872-876. doi: 10.1007/s00595-016-1462-x. Epub 2016 Dec 27.
To investigate the long-term morbidity of surgically treated esophageal atresia (EA) in adolescents and young adults and establish whether these long-term morbidities are affected by the type of EA.
We reviewed the medical records, including backgrounds and associated conditions, of 69 long-term survivors of EA, aged >15 years. The long-term morbidities included neurodevelopmental abnormality, nutritional impairment (short height <-2SD, low BMI <18.5), subjective symptoms, and musculoskeletal deformities. Comparisons of the results were made between Gross A-type EA (n = 6) and Gross C-type EA (n = 63).
All patients underwent esophageal anastomosis without esophageal replacement. Cardiac anomalies and long gap were present in 26 and 18%, respectively. Esophageal dilatation, fundoplication, and aortopexy were performed in 40, 34, and 18%, respectively. The incidence of long gap and esophageal stenosis was higher in Gross A-type EA than in Gross C-type EA. The long-term morbidities included neurodevelopmental abnormality (13%), nutritional impairment (62%: as short height in 34% and as low BMI in 46%), subjective symptoms (14%), and musculoskeletal deformities (59%). There were no differences in the long-term morbidities between Gross A and Gross C.
The incidence of the long-term morbidities is high in adolescents and young adults, regardless of the type of EA. Early detection of morbidity is important to improve the long-term outcomes of EA.
调查青少年和青年手术治疗食管闭锁（EA）的长期发病率，并确定这些长期发病率是否受EA类型的影响。
我们回顾了69例年龄大于15岁的EA长期存活者的病历，包括背景和相关情况。长期发病率包括神经发育异常、营养障碍（身高低于-2标准差、体重指数低<18.5）、主观症状和肌肉骨骼畸形。对大体A型EA（n = 6）和大体C型EA（n = 63）的结果进行比较。
所有患者均接受了食管吻合术，未进行食管置换。心脏异常和长段间隙分别占26%和18%。分别有40%、34%和18%的患者进行了食管扩张、胃底折叠术和主动脉固定术。大体A型EA的长段间隙和食管狭窄发生率高于大体C型EA。长期发病率包括神经发育异常（13%）、营养障碍（62%：身高低占34%，体重指数低占46%）、主观症状（14%）和肌肉骨骼畸形（59%）。大体A型和大体C型之间的长期发病率没有差异。
青少年和青年的长期发病率较高，与EA类型无关。早期发现发病率对改善EA的长期预后很重要。
