新生儿长段型食管闭锁 gross 型 A 和 B 外科治疗及主要并发症：系统评价。

Surgical treatment and major complications Within the first year of life in newborns with long-gap esophageal atresia gross type A and B - a systematic review.

机构信息

Surgical Department A, Odense University Hospital, Odense, Denmark.

Dept. of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland.

出版信息

J Pediatr Surg. 2019 Nov;54(11):2242-2249. doi: 10.1016/j.jpedsurg.2019.06.017. Epub 2019 Jun 27.

DOI:10.1016/j.jpedsurg.2019.06.017

PMID:31350044

Abstract

BACKGROUND

The surgical repair of long-gap esophageal atresia (LGEA) is still a challenge and there is no consensus on the preferred method of reconstruction. We performed a systematic review of the surgical treatment of LGEA Gross type A and B with the primary aim to compare the postoperative complications related to the different methods within the first postoperative year.

METHODS

Systematic literature review on the surgical repair of LGEA Gross type A and B within the first year of life published from January 01, 1996 to November 01, 2016.

RESULTS

We included 57 articles involving a total of 326 patients of whom 289 had a Gross type A LGEA. Delayed primary anastomosis (DPA) was the most applied surgical method (68.4%) in both types, followed by gastric pull-up (GPU) (8.3%). Anastomotic stricture (53.7%), gastro-esophageal reflux (GER) (32.2%) and anastomotic leakage (22.7%) were the most common postoperative complications, with stricture and GER occurring more often after DPA (61.9% and 40.8% respectively) compared to other methods (p < 0.001).

CONCLUSION

The majority of patients in this review were managed by DPA and postoperative complications were common despite the surgical method, with anastomotic stricture and GER being most common after DPA.

LEVEL OF EVIDENCE

Systematic review of case series and case reports with no comparison group (level IV).

摘要

背景

长段食管闭锁（LGEA）的手术修复仍然是一个挑战，对于重建的首选方法尚未达成共识。我们对 Gross 分型 A 和 B 型 LGEA 的手术治疗进行了系统评价，主要目的是比较术后 1 年内与不同方法相关的术后并发症。

方法

对 1996 年 1 月 1 日至 2016 年 11 月 1 日期间发表的 Gross 分型 A 和 B 型 LGEA 患者在出生后 1 年内接受手术修复的文献进行系统评价。

结果

共纳入 57 篇文章，涉及 326 例患者，其中 289 例为 Gross 分型 A 型 LGEA。在两种类型中，延迟一期吻合术（DPA）是最常用的手术方法（68.4%），其次是胃食管反流（GER）（32.2%）和吻合口漏（22.7%），吻合口狭窄（53.7%），胃食管反流（GER）（32.2%）和吻合口漏（22.7%）是最常见的术后并发症，DPA 后吻合口狭窄和 GER 的发生率高于其他方法（分别为 61.9%和 40.8%，均 P < 0.001）。