Macchini Francesco, Parente Giovanni, Morandi Anna, Farris Giorgio, Gentilino Valerio, Leva Ernesto
Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy.
Eur J Pediatr Surg. 2018 Jun;28(3):243-249. doi: 10.1055/s-0037-1598656. Epub 2017 Mar 6.
The aim of this study was to stratify anastomotic strictures (AS) following esophageal atresia (EA) repair and to establish predictors for the need of dilations.
A retrospective study on children operated on for EA between 2004 and 2014 was conducted. The stricture index (SI) was measured both radiologically (SI) and endoscopically (SI). A correlation analysis between the SI and the number of dilations was performed using Spearman's test and linear regression analysis.
In this study, 40 patients were included: 35 (87.5%) presented with Gross's type C EA, 3 (7.5%) type A, 1 (2.5%) type B, and 1 (2.5%) type D. The mean follow-up time was 101 ± 71.1 months (range: 7.8-232.5, median: 97.6). The mean SI was 0.56 ± 0.16 (range: 0.15-0.86). The mean SI was 0.45 ± 0.22 (range: 0.15-0.85). Twenty-four patients (60%) underwent a mean of 2 endoscopic dilations (range: 1-9). The number of dilations was poorly correlated with SI, while significantly correlated with SI. Patients who did not need dilations had a SI < 0.33, patients who needed only one dilation had 0.33 ≤ SI < 0.44, and those with SI ≥ 0.44 needed two or more dilations. No significant association with other clinical variables was found. All patients were asymptomatic at the time of the first endoscopy.
SI is a useful tool to classify AS and can represent a predictor of the need for endoscopic dilation. The role of the SI becomes even more important as clinical characteristics have a low predictive value for the development of an AS and the need for subsequent endoscopic esophageal dilatations.
本研究的目的是对食管闭锁（EA）修复术后的吻合口狭窄（AS）进行分层，并确定扩张需求的预测因素。
对2004年至2014年间接受EA手术的儿童进行回顾性研究。通过放射学（SI）和内镜检查（SI）测量狭窄指数（SI）。使用Spearman检验和线性回归分析对SI与扩张次数进行相关性分析。
本研究纳入40例患者：35例（87.5%）为格罗斯C型EA，3例（7.5%）为A型，1例（2.5%）为B型，1例（2.5%）为D型。平均随访时间为101±71.1个月（范围：7.8 - 232.5，中位数：97.6）。平均SI为0.56±0.16（范围：0.15 - 0.86）。平均SI为0.45±0.22（范围：0.15 - 0.85）。24例患者（60%）平均接受了2次内镜扩张（范围：1 - 9次）。扩张次数与SI的相关性较差，而与SI显著相关。不需要扩张的患者SI < 0.33，仅需要一次扩张的患者0.33≤SI < 0.44，而SI≥0.44的患者需要两次或更多次扩张。未发现与其他临床变量有显著关联。所有患者在首次内镜检查时均无症状。
SI是对AS进行分类的有用工具，可作为内镜扩张需求的预测指标。由于临床特征对AS发生及后续内镜食管扩张需求的预测价值较低，SI的作用变得更加重要。
