Rintala Risto J
Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Front Pediatr. 2017 May 15;5:109. doi: 10.3389/fped.2017.00109. eCollection 2017.
Patients with esophageal atresia (EA) suffer from abnormal and permanent esophageal intrinsic and extrinsic innervation that affects severely esophageal motility. The repair of EA also results in esophageal shortening that affects distal esophageal sphincter mechanism. Consequently, gastroesophageal reflux (GER) is common in these patients, overall approximately half of them suffer from symptomatic reflux. GER in EA patients often resists medical therapy and anti-reflux surgery in the form of fundoplication is required. In patients with pure and long gap EA, the barrier mechanisms against reflux are even more damaged, therefore, most of these patients undergo fundoplication during first year of life. Other indications for anti-reflux surgery include recalcitrant anastomotic stenoses and apparent life-threatening episodes. In short term, fundoplication alleviates symptoms in most patients but recurrences are common occurring in at least one third of the patients. Patients with fundoplication wrap failure often require redo surgery, which may be complicated and associated with significant morbidity. A safe option in a subset of patients with failed anti-reflux surgery appears to be long-term medical treatment with proton pump inhibitors.
食管闭锁（EA）患者存在异常且永久性的食管内在和外在神经支配，这严重影响食管动力。EA的修复还会导致食管缩短，进而影响远端食管括约肌机制。因此，胃食管反流（GER）在这些患者中很常见，总体上约有一半患者有症状性反流。EA患者的GER通常对药物治疗有抵抗，需要进行胃底折叠术形式的抗反流手术。在单纯性长间隙EA患者中，抗反流的屏障机制受损更严重，因此，这些患者中的大多数在出生后第一年内接受胃底折叠术。抗反流手术的其他指征包括顽固性吻合口狭窄和明显危及生命的发作。短期内，胃底折叠术可缓解大多数患者的症状，但复发很常见，至少三分之一的患者会出现复发。胃底折叠术包裹失败的患者通常需要再次手术，这可能很复杂且伴有明显的发病率。对于一部分抗反流手术失败的患者，一个安全的选择似乎是长期使用质子泵抑制剂进行药物治疗。
