先天性食管闭锁合并气管食管瘘患儿行食管食管吻合术后从婴儿期到学龄期的生活质量变化：开胸手术与胸腔镜手术的比较
Changes in quality of life from infancy to school age after esophagoesophagostomy for tracheoesophageal fistula: thoracotomy versus thoracoscopy.
作者信息
Miyano Go, Seo Shogo, Nakamura Hiroki, Sueyoshi Ryo, Okawada Manabu, Doi Takashi, Koga Hiroyuki, Lane Geoffrey J, Yamataka Atsuyuki
机构信息
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
出版信息
Pediatr Surg Int. 2017 Oct;33(10):1087-1090. doi: 10.1007/s00383-017-4141-0. Epub 2017 Aug 22.
BACKGROUND
We assessed the quality of life (QOL) of postoperative esophageal atresia (EA) with tracheoesophageal fistula (TEF) cases, comparing open with thoracoscopic repair.
METHODS
A retrospective review of consecutive EA/TEF repairs (2001-2014) was performed, excluding cases with birth weight less than 2000 g and severe cardiac/chromosomal anomalies. Of 37 cases, 13 had thoracoscopic repair (TR) and 24 had open repair (OR) according to the operating surgeon's preference. QOL was determined regularly by scoring responses to a standard questionnaire about oral intake, vomiting, bougienage, coughing, growth retardation, learning ability, and thoracic deformity. Lower scores reflected poorer outcome. QOL after TR and OR was compared 1 year postoperatively (POQ) and after starting school (ScQ).
RESULTS
Subject demographics were similar. Apart from two anastomotic leaks that resolved spontaneously after TR, there were no intraoperative complications or recurrence of TEF. Laparoscopic fundoplication was required for gastroesophageal reflux in four cases (OR 1; TR 3) (p = ns). QOL scores went from 6.5 → 11.5 in OR and 4.6 → 11.3 in TR, respectively. Final ScQ scores were similar, but POQ was significantly higher after OR (p < 0.05).
CONCLUSION
Initial QOL scores were significantly lower after TR, but by school age QOL scores were similar.
背景
我们评估了术后食管闭锁（EA）合并气管食管瘘（TEF）病例的生活质量（QOL），比较了开放手术与胸腔镜修复术的效果。
方法
对连续的EA/TEF修复手术（2001 - 2014年）进行回顾性研究，排除出生体重低于2000克以及患有严重心脏/染色体异常的病例。在37例病例中，根据手术医生的偏好，13例行胸腔镜修复术（TR），24例行开放修复术（OR）。通过对一份关于经口摄入量、呕吐、探条扩张、咳嗽、生长发育迟缓、学习能力和胸廓畸形的标准问卷的回答进行评分，定期确定生活质量。分数越低表明结果越差。比较TR和OR术后1年（术后1年QOL，POQ）以及入学后（入学后QOL，ScQ）的生活质量。
结果
受试者的人口统计学特征相似。除了TR术后有两例吻合口漏自行愈合外，无术中并发症或TEF复发。4例（OR组1例；TR组3例）因胃食管反流需要行腹腔镜胃底折叠术（p = 无显著性差异）。OR组的生活质量评分从6.5提高到11.5，TR组从4.6提高到11.3。最终ScQ评分相似，但OR术后POQ显著更高（p < 0.05）。
结论
TR术后初始生活质量评分显著较低，但到学龄期时生活质量评分相似。
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