Stadil Tatjana, Koivusalo Antti, Pakarinen Mikko, Mikkelsen Audun, Emblem Ragnhild, Svensson Jan F, Ehrén Henrik, Jönsson Linus, Bäckstrand Jakob, Lilja Helene Engstrand, Donoso Felipe, Thorup Jørgen Mogens, Sæter Thorstein, Rasmussen Lars, Pedersen Rikke Neess, Stenström Pernilla, Arnbjörnsson Einar, Óskarsson Kristján, Qvist Niels
Surgical Department A, Odense University Hospital, Odense, Denmark.
Dept. of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland.
J Pediatr Surg. 2019 Mar;54(3):423-428. doi: 10.1016/j.jpedsurg.2018.07.023. Epub 2018 Sep 1.
Several surgical procedures have been described in the reconstruction of long-gap esophageal atresia (LGEA). We reviewed the surgical methods used in children with LGEA in the Nordic countries over a 15-year period and the postoperative complications within the first postoperative year.
Retrospective multicenter medical record review of all children born with Gross type A or B esophageal atresia between 01/01/2000 and 12/31/2014 reconstructed within their first year of life.
We included 71 children; 56 had Gross type A and 15 type B LGEA. Delayed primary anastomosis (DPA) was performed in 52.1% and an esophageal replacement procedure in 47.9%. Gastric pull-up (GPU) was the most frequent procedure (25.4%). The frequency of chromosomal abnormalities, congenital heart defects and other anomalies was significantly higher in patients who had a replacement procedure. The frequency of gastroesophageal reflux (GER) was significantly higher after DPA compared to esophageal replacement (p = 0.013). At 1-year follow-up the mean body weight was higher after DPA than after organ interposition (p = 0.043).
DPA and esophageal replacement procedures were equally applied. Postoperative complications and follow-up were similar except for the development of GER and the body weight at 1-year follow-up. Long-term results should be investigated.
Treatment study.
Level III.
在长间隙食管闭锁（LGEA）的重建中已经描述了几种外科手术方法。我们回顾了北欧国家15年间LGEA患儿所采用的手术方法以及术后第一年内的并发症。
对2000年1月1日至2014年12月31日出生后第一年接受重建手术的所有A或B型食管闭锁患儿进行回顾性多中心病历审查。
我们纳入了71名患儿；56例为A型LGEA，15例为B型LGEA。52.1%的患儿进行了延迟一期吻合术（DPA），47.9%的患儿进行了食管替代手术。胃上提术（GPU）是最常用的手术方法（25.4%）。接受替代手术的患者染色体异常、先天性心脏缺陷和其他异常的发生率显著更高。与食管替代术相比，DPA术后胃食管反流（GER）的发生率显著更高（p = 0.013）。在1年随访时，DPA术后的平均体重高于器官置入术后（p = 0.043）。
DPA和食管替代手术的应用相当。除了GER的发生和1年随访时的体重外，术后并发症和随访情况相似。应研究长期结果。
治疗研究。
三级。
