Dittrich René, Stock Philippe, Rothe Karin, Degenhardt Petra
Charité Universitaetsmedizin Berlin, Department of Pediatric Surgery, Augustenburger Platz 1, 13353 Berlin.
Charité Universitaetsmedizin Berlin, Department of Pediatric Pulmonology and Immunology, Augustenburger Platz 1, 13353 Berlin; Altonaer Kinderkrankenhaus, Bleickenallee 38, 22763 Hamburg.
J Pediatr Surg. 2017 Aug;52(8):1255-1259. doi: 10.1016/j.jpedsurg.2016.12.025. Epub 2017 Jan 3.
The aim of this study was to illustrate the pulmonary long term outcome of patients with repaired esophageal atresia and to further examine causes and correlations that might have led to this outcome.
Twenty-seven of 62 possible patients (43%) aged 5-20years, with repaired esophageal atresia were recruited. Body plethysmography and spirometry were performed to evaluate lung function, and the Bruce protocol treadmill exercise test to assess physical fitness. Results were correlated to conditions such as interpouch distance, gastroesophageal reflux or duration of post-operative mechanical ventilation.
Seventeen participants (63%) showed abnormal lung function at rest or after exercise. Restrictive ventilatory defects (solely restrictive or combined) were found in 11 participants (41%), and obstructive ventilatory defects (solely obstructive or combined) in 13 subjects (48%). Twenty-two participants (81%) performed the Bruce protocol treadmill exercise test to standard. The treadmill exercise results were expressed in z-score and revealed to be significantly below the standard population mean (z-score=-1.40). Moreover, significant correlations between restrictive ventilatory defects and the interpouch distance; duration of post-operative ventilation; gastroesophageal reflux disease; plus recurrent aspiration pneumonia during infancy; were described.
It was shown that esophageal atresia and associated early complications have significant impact on pulmonary long term outcomes such as abnormal lung function and, in particular restrictive ventilatory defects. Long-running and regular follow-ups of patients with congenital esophageal atresia are necessary in order to detect and react to the development and progression of associated complications such as ventilation disorders or gastroesophageal reflux disease.
Prognosis study, Level II.
本研究旨在阐述食管闭锁修复术后患者的肺部长期预后，并进一步探究可能导致该预后的原因及相关性。
招募了62例年龄在5至20岁、食管闭锁已修复的患者中的27例（43%）。进行体容积描记法和肺活量测定以评估肺功能，并采用布鲁斯方案进行平板运动试验以评估体能。结果与诸如囊袋间距、胃食管反流或术后机械通气持续时间等情况相关。
17名参与者（63%）在静息或运动后显示肺功能异常。11名参与者（41%）存在限制性通气缺陷（单纯限制性或混合性），13名受试者（48%）存在阻塞性通气缺陷（单纯阻塞性或混合性）。22名参与者（81%）完成了标准的布鲁斯方案平板运动试验。平板运动试验结果以z评分表示，显示明显低于标准人群平均值（z评分 = -1.40）。此外，还描述了限制性通气缺陷与囊袋间距、术后通气持续时间、胃食管反流病以及婴儿期反复吸入性肺炎之间的显著相关性。
结果表明，食管闭锁及相关早期并发症对肺部长期预后有重大影响，如肺功能异常，尤其是限制性通气缺陷。对于先天性食管闭锁患者，需要进行长期定期随访，以便检测并应对相关并发症（如通气障碍或胃食管反流病）的发生和发展。
预后研究，二级。
