Castle Shannon L, Isani Mubina, Torres Manuel B, Anselmo Dean M, Nguyen Nam X
1 Department of Surgery, Children's Hospital Los Angeles , Los Angeles, California.
2 Department of Surgery, Miller Children's Hospital, Long Beach Memorial Medical Center , Long Beach, California.
J Laparoendosc Adv Surg Tech A. 2017 Apr;27(4):427-429. doi: 10.1089/lap.2016.0510. Epub 2017 Jan 5.
Conditions requiring an esophagectomy and esophageal replacement are rare in children. The preferred method and ideal replacement organ continue to be debated. We present long-term outcomes in children treated with esophagectomy and gastric pull-up.
We conducted a retrospective review of all the patients who underwent a esophagectomy and gastric pull-up at two major pediatric institutions from 2004 to 2015. Follow-up data were obtained for children when available, including any postoperative complications, need for dilation of strictures, and current feeding method.
Minimally invasive procedures were performed on 7 patients (5 female and 2 male) with a median age of 3 years (range 2-20, standard deviation = 8). Three patients successfully underwent laparoscopic transhiatal esophagectomy and cervical gastric pull-up, and three patients successfully underwent combined laparoscopic and right thoracoscopic (Ivor-Lewis) esophagectomy and cervical gastric pull-up. We identified an additional 3 patients who had an open esophagectomy and gastric pull-up. Seven patients had tubularized gastric conduits, six without pyloroplasty and one with pyloroplasty. For those patients with tubularized conduits, the average time to achieve full oral feeds was 16 days, with 1 patient with pyloroplasty who took 27 days. Of the three whole-stomach conduits, one reached oral independence at 19 days and the other two had yet tolerated anything per os. Follow-up data were available for all patients. At the average 5 years follow-up (ranging from 1 month to 7 years), all but two were thriving well with full oral feeds.
Minimally invasive esophagectomy and gastric pull-up is a good alternative in managing pediatric patients in need of esophagectomy and replacement; it offers acceptable early and long-term outcomes. Tubularized conduit appears to be superior to using the whole stomach and potentially avoids pyloroplasty. Ongoing study is needed to validate our findings.
儿童中需要进行食管切除术和食管替代术的情况很少见。首选方法和理想的替代器官仍存在争议。我们展示了接受食管切除术和胃上提术治疗的儿童的长期结果。
我们对2004年至2015年在两家主要儿科机构接受食管切除术和胃上提术的所有患者进行了回顾性研究。在可行的情况下获取了儿童的随访数据，包括任何术后并发症、狭窄扩张的需求以及当前的喂养方式。
对7例患者（5例女性和2例男性）进行了微创手术，中位年龄为3岁（范围2 - 20岁，标准差 = 8）。3例患者成功接受了腹腔镜经裂孔食管切除术和颈部胃上提术，3例患者成功接受了腹腔镜联合右胸腹腔镜（艾弗 - 刘易斯）食管切除术和颈部胃上提术。我们还确定了另外3例接受开放食管切除术和胃上提术的患者。7例患者使用了管状胃管道，6例未进行幽门成形术，1例进行了幽门成形术。对于那些使用管状管道的患者，实现完全经口喂养的平均时间为16天，1例进行幽门成形术的患者用时27天。在3例全胃管道患者中，1例在19天达到经口自主进食，另外2例仍不能经口耐受任何食物。所有患者均有随访数据。在平均5年的随访（范围从1个月至7年）中，除2例患者外，其余患者均经口全量喂养，生长良好。
微创食管切除术和胃上提术是治疗需要食管切除术和替代术的儿科患者的良好选择；它提供了可接受的早期和长期结果。管状管道似乎优于使用全胃，并且可能避免幽门成形术。需要进行进一步的研究来验证我们的发现。
