Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.
Department of Neonatology, University Hospital, Goethe University Frankfurt,Frankfurt am Main, Germany.
Dis Esophagus. 2021 Apr 7;34(4). doi: 10.1093/dote/doaa093.
The aim of this study was to evaluate the outcome of esophageal atresia in Germany in a retrospective observational study of a large cohort. Data from the major health insurance company in Germany, which covers approximately 30% of German patients, were analyzed. All patients born and registered between 2009 and 2013 with a diagnosis of esophageal atresia at first admission to the hospital were included. Mortality was analyzed during the first year of life. We identified 287 patients with esophageal atresia, including 253 with and 34 without tracheoesophageal fistula. Associated anomalies were found in 53.7% of the patients; the most frequent were cardiac anomalies (41.8%), anomalies of the urinary tract (17.4%), and atresia of the colon, rectum, and anus (9.4%). Forty-one patients (14.3%) had a birth weight <1500 g. Seventeen patients (5.9%) died before surgery. Gastrostomy was performed during the index admission in 70 patients (25.9%). The reconstruction of the esophageal passage was performed in 247 patients (93.9%). Forty-eight percent of the patients who underwent an operation required dilatation. The mortality rate in the patients who underwent an operation was 10.4%. These results from Germany correspond to the international results that have been reported. The number of dilatations was in the middle of the range of those reported in the literature; the overall mortality rate was in the upper portion of the range of the international rates. Efforts should be made to establish a clinical registry to measure and improve the quality of care for this and other rare conditions.
本研究旨在通过对德国一家大型医疗保险公司的回顾性观察性研究，评估食管闭锁的治疗结果。该保险公司覆盖了约 30%的德国患者。分析了 2009 年至 2013 年间首次住院诊断为食管闭锁的所有患者的数据。在患者生命的第一年，对死亡率进行了分析。共纳入 287 例食管闭锁患者，其中 253 例伴气管食管瘘，34 例不伴气管食管瘘。53.7%的患者合并有其他畸形，最常见的是心脏畸形（41.8%）、泌尿系统畸形（17.4%）、结肠、直肠和肛门闭锁（9.4%）。41 例（14.3%）患儿出生体重<1500g。17 例（5.9%）患儿在术前死亡。70 例（25.9%）患儿在入院时行胃造口术。247 例（93.9%）患儿进行了食管重建手术。48%的手术患儿需要进行扩张治疗。手术患儿的死亡率为 10.4%。德国的这些结果与国际报道的结果相符。扩张治疗的例数处于文献报道的中位数范围，整体死亡率处于国际报道范围的较高端。应努力建立临床登记系统，以衡量和提高对这类和其他罕见疾病的治疗质量。
