Liu Shi-Qi, Lv Yi, Fang Ying, Luo Rui-Xue, Zhao Jing-Ru, Luo Ruo-Gu, Li Yi-Mei, Zhang Jing, Zhang Peng-Fei, Guo Jin-Zhen, Li Qing-Hong, Han Ming-Xing
Medical College, Xijing University.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University.
Medicine (Baltimore). 2020 Oct 16;99(42):e22472. doi: 10.1097/MD.0000000000022472.
Neonatal long-gap esophageal atresia (LGEA) with tracheoesophageal fistula (TEF) is an uncommon but serious congenital malformation of the esophagus in newborns, and it remains challenging for pediatric surgeons. Magnetic compress has been shown to be effective for the treatment of LGEA in children and adults. However, the implementation of this unique technique for neonatal LGEA has not been evaluated.
A female infant was born at 37 weeks of gestation. Prenatal ultrasound imaging revealed signs of esophageal atresia, including the absence of the gastric bubble and polyhydramnios.
A diagnosis of LGEA with TEF was confirmed at birth by contrast X-ray.
She was treated with magnetic compression anastomosis (MCA) following an esophago-esophagostomy. Two magnetic rings were customized, and the MCA was conducted during the same stage surgery of ligating the TEF. Under the magnetic force, the 2 magnet rings pulled along the gastric tube to achieve anastomosis. The postoperative permanent suction of these 2 pouches was instituted, and spontaneous growth was awaited. Magnet removal was performed at 36 days, and enteral nutrition was continued via a gastric tube for 4 weeks at post-operation.
The upper gastrointestinal contrast confirmed the anastomotic patency perfectly after 3 months. The patient was followed up for 18 months, and exhibited durable esophageal patency without dysphagia.
These results suggest that MCA is feasible and effective for treating LGEA in infants.
新生儿长段食管闭锁（LGEA）合并气管食管瘘（TEF）是新生儿中一种罕见但严重的先天性食管畸形，对小儿外科医生来说仍然具有挑战性。磁压缩已被证明对儿童和成人的LGEA治疗有效。然而，这种独特技术在新生儿LGEA中的应用尚未得到评估。
一名女婴在孕37周出生。产前超声成像显示食管闭锁迹象，包括胃泡缺失和羊水过多。
出生时通过造影X线确诊为LGEA合并TEF。
在食管 - 食管造口术后，她接受了磁压缩吻合术（MCA）。定制了两个磁环，并在结扎TEF的同期手术中进行MCA。在磁力作用下，两个磁环沿胃管拉动以实现吻合。术后对这两个囊袋进行持续吸引，并等待自然生长。在术后36天取出磁体，术后通过胃管继续肠内营养4周。
3个月后上消化道造影完美证实吻合口通畅。对患者进行了18个月的随访，显示食管通畅持久，无吞咽困难。
这些结果表明MCA治疗婴儿LGEA是可行且有效的。
