Jones Ceri E, Smyth Rachel, Drewett Melanie, Burge David M, Hall Nigel J
Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK; University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
J Surg Res. 2020 Oct;254:334-339. doi: 10.1016/j.jss.2020.05.004. Epub 2020 Jun 7.
Anastomotic stricture is a significant cause of morbidity after repair of esophageal atresia (EA). Exposure to gastric acid has been postulated to contribute to stricture development and severity leading to prophylactic antacid use by some surgeons. We investigated the association between administration of antacid medication and the development of anastomotic strictures.
Retrospective case-note review of consecutive infants undergoing repair of EA with distal tracheoesophageal fistula (type C) between January 1994 and December 2014. Only infants who underwent primary esophageal anastomosis at initial surgical procedure were included. Stricture-related outcomes were compared initially for infants who received prophylactic antacid medication (PAAM) versus no prophylaxis, and the role of PAAM in stricture prevention was explored in a multivariate model. Outcomes were also compared for infants grouped by antacid use at any stage.
One hundred fourteen infants were included. Sixteen infants received PAAM at surgeon preference. Of the remaining 98 infants, 44 subsequently received antacid as treatment for gastroesophageal reflux (GER) and 54 never received antacid medication. There was no statistically significant association between incidence of stricture in the first year (10 of 16 versus 41 of 98; P = 0.18) nor time to first stricture (median, 57 d [41-268] versus 102 d [43-320]; P = 0.89) and administration of PAAM. Similarly, there were no statistically significant associations between incidence of stricture, age at first stricture and number of dilatations, and administration of antacid medication either as prophylaxis nor when given as treatment for symptoms or signs of GER.
These data do not support the hypothesis that PAAM reduces the incidence or severity of anastomotic stricture after repair of EA. Treatment with antacids may be best reserved for those with symptoms or signs of GER. Further prospective investigation of the role of antacid prophylaxis on stricture formation after EA repair is warranted.
吻合口狭窄是食管闭锁（EA）修复术后发病的重要原因。据推测，胃酸暴露会促使狭窄的发生和加重，导致一些外科医生使用预防性抗酸剂。我们研究了抗酸药物的使用与吻合口狭窄发生之间的关联。
对1994年1月至2014年12月期间连续接受伴有远端气管食管瘘（C型）的EA修复术的婴儿进行回顾性病例记录审查。仅纳入在初次手术时进行一期食管吻合的婴儿。最初比较接受预防性抗酸药物（PAAM）与未进行预防的婴儿的狭窄相关结局，并在多变量模型中探讨PAAM在预防狭窄中的作用。还比较了在任何阶段按抗酸剂使用情况分组的婴儿的结局。
共纳入114例婴儿。16例婴儿根据外科医生的偏好接受了PAAM。在其余98例婴儿中，44例随后接受抗酸剂治疗胃食管反流（GER），54例从未接受过抗酸药物治疗。第一年狭窄发生率（16例中的10例与98例中的41例；P = 0.18）以及首次出现狭窄的时间（中位数，57天[41 - 268]与102天[43 - 320]；P = 0.89）与PAAM的使用之间无统计学显著关联。同样，无论是作为预防措施还是在用于治疗GER症状或体征时，抗酸药物的使用与狭窄发生率、首次狭窄时的年龄以及扩张次数之间均无统计学显著关联。
这些数据不支持PAAM可降低EA修复术后吻合口狭窄发生率或严重程度这一假设。抗酸剂治疗可能最好仅用于有GER症状或体征的患者。有必要进一步前瞻性研究抗酸剂预防在EA修复术后狭窄形成中的作用。
