Lindahl H, Rintala R, Louhimo I
Helsinki University Children's Hospital, Finland.
J Pediatr Surg. 1989 Oct;24(10):985-7. doi: 10.1016/s0022-3468(89)80198-8.
During the 5-year period from 1981 to 1985, Nissen fundoplication was performed on 13 esophageal atresia patients. One patient with Down's syndrome died because of cardiac malformation 2 weeks after the operation and is excluded from the analysis. Nine of the remaining 12 patients had the usual malformation with distal fistula, while three had isolated atresia. In eight patients there was a long gap between the segments, and in five Livaditis myotomy was necessary. The median age of the patients at the fundoplication was 1.3 years (range, 4.5 months to 10.6 years). The main clinical manifestations were anastomotic stricture (six patients), respiratory complications (three patients), vomiting and difficulties in feeding (two patients), and esophagitis only (one patient). Altogether nine patients had preoperative distal esophagitis. Mean follow-up time was 4.1 years (range, 2.0 to 6.4 years). All patients primarily benefited from the operation. Routine control endoscopy 3 to 8 months after the operation showed a competent fundoplication in all patients. However, in five patients the reflux later recurred, and endoscopy revealed a partially disrupted fundal wrap and esophagitis. Four patients underwent refundoplication and one is waiting for it as of this writing. Four patients had Barrett's esophagus at the last endoscopic control. There was one late death due to cardiac failure. In conclusion, although the short-term results of Nissen fundoplication in esophageal atresia patients are good, the risk for late recurrence is high. Regular long-term follow-up is therefore necessary.
在1981年至1985年的5年期间，对13例食管闭锁患者实施了nissen胃底折叠术。1例唐氏综合征患者术后2周因心脏畸形死亡，被排除在分析之外。其余12例患者中，9例有常见畸形伴远端瘘管，3例为单纯闭锁。8例患者的节段间有长间隙，5例需要进行利瓦迪蒂斯肌切开术。接受胃底折叠术患者的中位年龄为1.3岁（范围为4.5个月至10.6岁）。主要临床表现为吻合口狭窄（6例）、呼吸系统并发症（3例）、呕吐和喂养困难（2例）以及仅食管炎（1例）。共有9例患者术前有远端食管炎。平均随访时间为4.1年（范围为2.0至6.4年）。所有患者均从手术中初步获益。术后3至8个月的常规对照内镜检查显示所有患者的胃底折叠术功能良好。然而，5例患者后来出现反流，内镜检查显示胃底包裹部分破裂和食管炎。4例患者接受了再次胃底折叠术，1例截至撰写本文时正在等待手术。在最后一次内镜检查时，4例患者有巴雷特食管。有1例因心力衰竭晚期死亡。总之，尽管nissen胃底折叠术治疗食管闭锁患者的短期效果良好，但晚期复发风险很高。因此，有必要进行定期长期随访。
