极低和超低出生体重食管闭锁/远端气管食管瘘患儿一期修复的结局

Outcome of primary repair in extremely and very low-birth-weight infants with esophageal atresia/distal tracheoesophageal fistula.

作者信息

Schmidt Andreas, Obermayr Florian, Lieber Justus, Gille Christian, Fideler Frank, Fuchs Joerg

机构信息

Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.

Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany; Department of Pediatric Surgery, University Hospital, Philipps University Marburg, Baldingerstrasse, 35043 Marburg, Germany.

出版信息

J Pediatr Surg. 2017 Oct;52(10):1567-1570. doi: 10.1016/j.jpedsurg.2017.05.011. Epub 2017 May 17.

DOI:10.1016/j.jpedsurg.2017.05.011

PMID:28554817

Abstract

PURPOSE

The optimal surgical management of extremely (ELBW) and very low-birth-weight (VLBW) neonates with esophageal atresia and distal tracheoesophageal fistula (EA/TEF) (Gross type C) is still debated. The aim of this study was to evaluate the surgical outcome of primary repair in these patients and compare it to ≥1500g neonates.

METHODS

Medical records of neonates with repaired EA from 2002 to 2016 were reviewed.

RESULTS

4 ELBW, 7 VLBW, and 24 ≥1500g infants had type C EA/TEF and underwent primary repair. Anastomotic leakage occurred in 0% ELBW, 0% VLBW and 8.3% ≥1500g patients and anastomotic stricture in 25% ELBW, 28.5% VLBW and 37.5% ≥1500g patients. 50% ELBW, 14.2% VLBW and 20.8% ≥1500g patients underwent secondary fundoplication. One patient of the VLBW group and one patient of the ≥1500g group died postoperatively of causes not related to EA/TEF.

CONCLUSIONS

In extremely and very low-birth-weight neonates with type C EA/TEF surgical outcome after primary repair is comparable to the outcome in ≥1500g neonates. Primary repair can be performed in most of these patients and staged repair can be restricted to unstable patients.

LEVEL OF EVIDENCE

Treatment study level III.

摘要

目的

对于极低出生体重（ELBW）和超低出生体重（VLBW）且患有食管闭锁合并远端气管食管瘘（EA/TEF）（格罗斯C型）的新生儿，最佳手术管理方案仍存在争议。本研究旨在评估这些患者一期修复的手术结果，并与出生体重≥1500g的新生儿进行比较。

方法

回顾了2002年至2016年接受EA修复的新生儿的病历。

结果

4例ELBW、7例VLBW和24例出生体重≥1500g的婴儿患有C型EA/TEF并接受了一期修复。吻合口漏发生率在ELBW患者中为0%，VLBW患者中为0%，出生体重≥1500g的患者中为8.3%；吻合口狭窄发生率在ELBW患者中为25%，VLBW患者中为28.5%，出生体重≥1500g的患者中为37.5%。50%的ELBW患者、14.2%的VLBW患者和20.8%的出生体重≥1500g的患者接受了二期胃底折叠术。VLBW组和出生体重≥1500g组各有1例患者术后死于与EA/TEF无关的原因。