Liu Jia, Yang Yifan, Zheng Chao, Dong Rui, Zheng Shan
Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China.
Medicine (Baltimore). 2017 May;96(21):e6942. doi: 10.1097/MD.0000000000006942.
Esophageal replacement (ER) surgery has been widely used in long-gap esophageal atresia (LGEA) over the past few decades. The most commonly used surgical approaches in many pediatric surgical centers include colon interposition (CI), gastric pull-up (GPU), jejunal interposition (JI), and gastric tube reconstruction (GTR). However, there is no systematic evidence on which is the optimal conduit for the native esophagus. The aim of this systematic review was to evaluate the short- and long-term outcomes among these 4 replacement approaches in LGEA cases based on current evidence.
PubMed, Web of Science, Cochrane Library, and EMBASE were searched for relevant literature on November 18 2016. Studies on ER in LGEA were reviewed and selected according to eligibility criteria. We focused on surgical outcomes regarding to different replacement approaches, including postoperative complications and long-term follow-up. Both detailed descriptions of single studies and pooled data analysis were conducted. Data were computed by Reviewer Manager 5.3.
Twenty-three studies were included (4 comparative retrospective, 3 prospective, and 16 retrospective) with a total of 593 patients (393 LGEA, 66.3%). The number of patients with available data for analysis was 534 (90.1%), including 127 patients (98 LGEA) of GPU, 335 (223 LGEA) of CI, 45 (all LGEA) of JI, and 27 (all LGEA) of GTR. Follow-up information was provided in 15 studies. Anastomotic leak and stricture, respiratory problems, and gastroesophageal reflux were analyzed as major postoperative complications. Long-term follow-ups were concentrated on growth and feeding conditions.
Current evidence on short- and long-term outcomes of ER in LGEA patients was limited, and proper prospective comparative studies were lacking. This present systematic review indicates CI and GPU as comparable and favorable approaches, especially CI in the long-term outcomes. Studies on JI and GTR were limited, which need larger sample size to assess their validity and outcomes.
在过去几十年中，食管替代（ER）手术已广泛应用于长段食管闭锁（LGEA）。许多儿科手术中心最常用的手术方法包括结肠代食管术（CI）、胃上提术（GPU）、空肠代食管术（JI）和胃管重建术（GTR）。然而，尚无关于哪种是天然食管最佳替代管道的系统性证据。本系统评价的目的是根据现有证据评估这4种替代方法在LGEA病例中的短期和长期结局。
于2016年11月18日在PubMed、科学网、Cochrane图书馆和EMBASE中检索相关文献。根据纳入标准对LGEA的ER研究进行回顾和筛选。我们重点关注不同替代方法的手术结局，包括术后并发症和长期随访。对单个研究进行详细描述并进行汇总数据分析。数据由Reviewer Manager 5.3计算。
纳入23项研究（4项比较性回顾性研究、3项前瞻性研究和16项回顾性研究），共593例患者（393例LGEA，占66.3%）。有可用数据进行分析的患者数量为534例（占90.1%），包括127例GPU患者（98例LGEA）、335例CI患者（223例LGEA）、45例JI患者（均为LGEA）和27例GTR患者（均为LGEA）。15项研究提供了随访信息。吻合口漏和狭窄、呼吸问题以及胃食管反流被分析为主要术后并发症。长期随访集中在生长和喂养情况。
目前关于LGEA患者ER短期和长期结局的证据有限，且缺乏适当的前瞻性比较研究。本系统评价表明CI和GPU是可比且良好 的方法，尤其是CI在长期结局方面。关于JI和GTR的研究有限，需要更大样本量来评估其有效性和结局。
