Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool L14 5AB, United Kingdom.
Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool L14 5AB, United Kingdom; Institute Of Translational Medicine & Child Health, University of Liverpool, Liverpool L69 3BX, United Kingdom.
J Pediatr Surg. 2021 May;56(5):929-932. doi: 10.1016/j.jpedsurg.2020.11.023. Epub 2020 Nov 28.
To determine if birth-weight (BW) influences primary surgical management of newborns undergoing operation for esophageal atresia and tracheo-esophageal fistula (EA-TEF).
Newborns undergoing repair of esophageal atresia at a single specialist centre between 1999 and 2017 were categorised into three groups based on BW; Group A < 1.5 kg, Group B <2.5 kg and Group C >2.5 kg. Outcome data analysed were (i) technical ability of the surgeon to perform primary esophageal anastomosis, (ii) anastomotic leak, (iii) anastomotic stricture, (iv) esophageal replacement, (v) need for other procedures notably fundoplication, aortopexy, tracheostomy and (vi) mortality. Statistical analysis was performed using a two-tailed Fisher's exact test and logistic regression.
198 patients underwent surgery for EA-TEF during the study period, Group A (n = 13), Group B (n = 73) and Group C (n = 112). Inability to perform a primary anastomosis was significantly higher in Group A vs Group B (p = 0.003) and Group C (p = 0.004). Birthweight was a significant variable in the ability to perform a primary esophageal anastomosis (OR 1.009, p = 0.004). Mortality rate was significantly higher in Group A vs Group C (P = 0.0158).
Very low birth weight infants are less likely to achieve a definitive primary anastomosis during emergent repair of esophageal atresia, and have a higher mortality.
为了确定出生体重（BW）是否会影响接受食管闭锁和气管食管瘘（EA-TEF）手术的新生儿的主要手术治疗。
1999 年至 2017 年间，在一家专业中心接受食管闭锁修复的新生儿根据 BW 分为三组；A 组<1.5kg，B 组<2.5kg，C 组>2.5kg。分析的结果数据包括（i）外科医生进行原发性食管吻合术的技术能力，（ii）吻合口漏，（iii）吻合口狭窄，（iv）食管替代，（v）需要其他手术，特别是胃底折叠术、主动脉固定术、气管切开术，（vi）死亡率。使用双侧 Fisher 精确检验和逻辑回归进行统计学分析。
在研究期间，198 例患者接受了 EA-TEF 手术，A 组（n=13），B 组（n=73）和 C 组（n=112）。A 组与 B 组（p=0.003）和 C 组（p=0.004）相比，无法进行原发性吻合的可能性明显更高。出生体重是进行原发性食管吻合术能力的一个显著变量（OR 1.009，p=0.004）。A 组的死亡率明显高于 C 组（P=0.0158）。
极低出生体重婴儿在接受食管闭锁紧急修复时，更不可能实现确定性的原发性吻合，且死亡率更高。
