胸腔镜下食管闭锁合并远端气管食管瘘修补术：对于体重小于2000克的婴儿来说，这是一种安全的手术吗？
Thoracoscopic repair of esophageal atresia with distal tracheoesophageal fistula: is it a safe procedure in infants weighing less than 2000 g?
作者信息
Son Joonhyuk, Jang Yerang, Kim Wontae, Lee Sanghoon, Jeong Ji Seon, Lee Suk-Koo, Seo Jeong-Meen
机构信息
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
Department of Anesthesiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
出版信息
Surg Endosc. 2021 Apr;35(4):1597-1601. doi: 10.1007/s00464-020-07538-z. Epub 2020 Apr 22.
BACKGROUND
Since Rothenberg first performed thoracoscopic repair for esophageal atresia with distal tracheoesophageal fistula (EA/TEF) successfully in 2000, thoracoscopic repair has achieved status as a routine procedure worldwide. Previously, an international multicenter study reported that this procedure was not inferior to conventional open surgery. However, thoracoscopic surgery is a highly difficult operation for surgeons and anesthesiologists; as a result, the safety and efficacy of the surgery is still under debate. Considering these circumstances, the purpose of this study was to analyze the results of single-center thoracoscopic surgery and to compare the outcomes relative to the patient's weight at the time of surgery.
METHODS
We retrospectively analyzed patients with EA/TEF who underwent thoracoscopic surgery in a single center between October 2008 and February 2017.
RESULTS
In total, 41 cases of thoracoscopic repair of EA/TEF were performed. Upon subgrouping by over and under 2000 g of body weight at the time of operation, 34 were found to be over 2000 g and seven were under 2000 g. Intraoperative factors and events were not significantly different between the two groups. Additionally, most of the postoperative outcomes, including the rate of postoperative leakage and strictures, showed no difference. On the other hand, the under 2000 g group had more gastroesophageal reflux requiring fundoplication than did the heavier group (P = 0.04).
CONCLUSIONS
The results of this center's thoracoscopic repair of EA/TEF were not inferior to other centers' outcomes. Additionally, the intraoperative and postoperative outcomes were similar despite differences in weight at operation. Therefore, thoracoscopic repair might be a feasible surgical option for infants weighing less than 2000 g when performed by a surgeon and anesthesiologist team who are experienced in pediatric thoracoscopic surgery.
背景
自2000年罗滕伯格首次成功进行胸腔镜修复治疗食管闭锁合并远端气管食管瘘（EA/TEF）以来，胸腔镜修复术已在全球范围内成为一种常规手术。此前，一项国际多中心研究报告称，该手术并不逊色于传统开放手术。然而，胸腔镜手术对外科医生和麻醉医生来说是一项极具难度的手术；因此，该手术的安全性和有效性仍存在争议。考虑到这些情况，本研究的目的是分析单中心胸腔镜手术的结果，并比较与手术时患者体重相关的结局。
方法
我们回顾性分析了2008年10月至2017年2月在单中心接受胸腔镜手术的EA/TEF患者。
结果
共进行了41例EA/TEF的胸腔镜修复术。根据手术时体重超过和低于2000克进行亚组分析，发现34例体重超过2000克，7例体重低于2000克。两组之间的术中因素和事件无显著差异。此外，大多数术后结局，包括术后渗漏和狭窄率，均无差异。另一方面，体重低于2000克的组比体重较重的组有更多需要进行胃底折叠术的胃食管反流（P = 0.04）。
结论
该中心胸腔镜修复EA/TEF的结果并不逊色于其他中心的结果。此外，尽管手术时体重不同，但术中和术后结局相似。因此，对于体重小于2000克的婴儿，由经验丰富的小儿胸腔镜手术外科医生和麻醉医生团队进行胸腔镜修复可能是一种可行的手术选择。
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