Bastard François, Bonnard Arnaud, Rousseau Véronique, Gelas Thomas, Michaud Laurent, Irtan Sabine, Piolat Christian, Ranke-Chrétien Aline, Becmeur François, Dariel Anne, Lamireau Thierry, Petit Thierry, Fouquet Virginie, Le Mandat Aurélie, Lefebvre Francis, Allal Hossein, Borgnon Josephine, Boubnova Julia, Habonimana Edouard, Panait Nicoleta, Buisson Philippe, Margaryan Marc, Michel Jean-Luc, Gaudin Jean, Lardy Hubert, Auber Frédéric, Borderon Corinne, De Vries Philine, Jaby Olivier, Fourcade Laurent, Lecompte Jean François, Tolg Cécilia, Delorme Benoit, Schmitt Françoise, Podevin Guillaume
University Hospital, 4 rue Larrey, 49933 Angers, France.
Robert Debré University Hospital, 48 bd Serrurier, 75019 Paris, France.
J Pediatr Surg. 2018 Apr;53(4):605-609. doi: 10.1016/j.jpedsurg.2017.07.013. Epub 2017 Jul 21.
Thoracotomy as surgical approach for esophageal atresia treatment entails the risk of deformation of the rib cage and consequently secondary thoracogenic scoliosis. The aim of our study was to assess these thoracic wall anomalies on a large national cohort and search for factors influencing this morbidity.
Pediatric surgery departments from our national network were asked to send recent thoracic X-ray and operative reports for patients born between 2008 and 2010 with esophageal atresia. The X-rays were read in a double-blind manner to detect costal and vertebral anomalies.
Among 322 inclusions from 32 centers, 110 (34.2%) X-rays were normal and 25 (7.7%) displayed thoracic malformations, including 14 hemivertebrae. We found 187 (58.1%) sequelae of surgery, including 85 costal hypoplasia, 47 other types of costal anomalies, 46 intercostal space anomalies, 21 costal fusions and 12 scoliosis, with some patients suffering from several lesions. The rate of patients with these sequelae was not influenced by age at intervention, weight at birth, type of atresia, number of thoracotomy or size of the center. The rate of sequelae was higher following a classical thoracotomy (59.1%), whatever the way that thoracotomy was performed, compared to nonconverted thoracoscopy (22.2%; p=0.04).
About 60 % of the patients suffered from a thoracic wall morbidity caused by the thoracotomy performed as part of surgical treatment of esophageal atresia. Minimally invasive techniques reduced thoracic wall morbidity. Further studies should be carried out to assess the potential benefit of minimally invasive approaches to patient pulmonary functions and on the occurrence of thoracogenic scoliosis in adulthood.
Level III retrospective comparative treatment study.
开胸手术作为治疗食管闭锁的手术方法，存在胸廓变形的风险，进而导致继发性胸廓源性脊柱侧弯。我们研究的目的是在一个大型全国队列中评估这些胸壁异常情况，并寻找影响这种发病率的因素。
我们要求全国网络中的儿科外科科室提供2008年至2010年出生的食管闭锁患者的近期胸部X线片和手术报告。以双盲方式读取X线片以检测肋骨和椎体异常。
在来自32个中心的322例纳入病例中，110例（34.2%）X线片正常，25例（7.7%）显示胸廓畸形，包括14例半椎体。我们发现187例（58.1%）有手术后遗症，包括85例肋骨发育不全、47例其他类型的肋骨异常、46例肋间间隙异常、21例肋骨融合和12例脊柱侧弯，一些患者有多种病变。这些后遗症患者的比例不受干预时的年龄、出生体重、闭锁类型、开胸手术次数或中心规模的影响。无论开胸手术的实施方式如何，传统开胸手术后的后遗症发生率（59.1%）均高于未转换的胸腔镜手术（22.2%；p = 0.04）。
约6%的患者因作为食管闭锁手术治疗一部分的开胸手术而出现胸壁疾病。微创技术降低了胸壁疾病的发生率。应进一步开展研究，以评估微创方法对患者肺功能的潜在益处以及对成年期胸廓源性脊柱侧弯发生情况的影响。
III级回顾性对比治疗研究。
