Bradshaw Catherine Jane, Sloan Keren, Morandi Anna, Lakshminarayanan Bhanumathi, Cox Sharon Gail, Millar Alastair J W, Numanoglu Alp, Lakhoo Kokila
Department of Paediatric Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital and Institute of Child Health, Cape Town, Western Cape Province, South Africa.
Eur J Pediatr Surg. 2018 Feb;28(1):22-29. doi: 10.1055/s-0037-1607041. Epub 2017 Sep 25.
No consensus exists about the optimal surgical technique for esophageal replacement. This study reports the surgical outcomes for the gastric pull-up and the colonic interposition procedures.
A retrospective review of children undergoing esophageal replacement surgery between January 2001 and June 2015 across four different pediatric surgery centers was conducted. Data collected included indications, epidemiology, surgical technique, complications, and outcomes. Patients were divided into group A, those that had a gastric pull-up procedure and group B, those that had a colonic interposition procedure.
In total, 50 patients were included; 29 in group A and 21 in group B. Indications included esophageal atresia, caustic ingestion, and infective esophageal stricture. The median age at the time of surgery was 13 months. The mean length of follow-up was 5.2 years. Three patients died giving a mortality rate of 6%; 2 in group A and 1 in group B.In both groups, early postoperative complications included infective complications, such as wound infections, sepsis, and pneumonia (11), anastomotic leak (7), and respiratory complications (7). Late complications included adhesive bowel obstruction (2), anastomotic strictures (4), redundancy (1), and jejunostomy problems (1). Septic complications and anastomotic strictures occurred more frequently in group B. Further surgery was needed in eight patients; this was significantly higher in group B. Full oral feeding was achieved within 6 months in 91.5%.
The gastric pull-up and colonic interposition have comparable mortality and outcomes. The colonic interposition was associated with a higher rate of early septic complications, anastomotic strictures, and need for further surgery.
关于食管置换的最佳手术技术尚无共识。本研究报告了胃上提术和结肠间置术的手术结果。
对2001年1月至2015年6月期间在四个不同儿科手术中心接受食管置换手术的儿童进行回顾性研究。收集的数据包括适应证、流行病学、手术技术、并发症和结果。患者分为A组（接受胃上提术）和B组（接受结肠间置术）。
共纳入50例患者；A组29例，B组21例。适应证包括食管闭锁、腐蚀性物质摄入和感染性食管狭窄。手术时的中位年龄为13个月。平均随访时间为5.2年。3例患者死亡，死亡率为6%；A组2例，B组1例。两组术后早期并发症包括感染性并发症，如伤口感染、败血症和肺炎（11例）、吻合口漏（7例）和呼吸并发症（7例）。晚期并发症包括粘连性肠梗阻（2例）、吻合口狭窄（4例）、冗余（1例）和空肠造口问题（1例）。B组感染性并发症和吻合口狭窄发生率更高。8例患者需要进一步手术；B组显著更高。91.5%的患者在6个月内实现了完全经口喂养。
胃上提术和结肠间置术的死亡率和结果相当。结肠间置术与早期感染性并发症、吻合口狭窄发生率较高以及需要进一步手术有关。
