Boston Children's Hospital, Department of General Surgery; Children's Mercy Hospital, Department of Pediatric Surgery.
Boston Children's Hospital, Department of General Surgery.
J Pediatr Surg. 2021 Dec;56(12):2180-2191. doi: 10.1016/j.jpedsurg.2021.02.054. Epub 2021 Feb 26.
Esophageal growth using the Foker process (FP) for long-gap esophageal atresia (LGEA) has evolved over time.
Contemporary LGEA patients treated from 2014-2020 were compared to historical controls (2005 to <2014).
102 contemporary LGEA patients (type A 50%, B 18%, C 32%; 36% prior anastomotic attempt; 20 with esophagostomy) underwent either primary repair (n=23), jejunal interposition (JI; n = 14), or Foker process (FP; n = 65; 49 primary [p], 16 rescue [r]). The contemporary p-FP cohort experienced significantly fewer leaks on traction (4% vs 22%), bone fractures (2% vs 22%), anastomotic leak (12% vs 37%), and Foker failure (FP→JI; 0% vs 15%), when compared to historical p-FP patients (n = 27), all p ≤ 0.01. Patients who underwent a completely (n = 11) or partially (n = 11) minimally invasive FP experienced fewer median days paralyzed (0 vs 8 vs 17) and intubated (9 vs 15 vs 25) compared to open FP patients, respectively (all p ≤ 0.03), with equivalent leak rates (18% vs 9% vs 26%, p = 0.47). At one-year post-FP, most patients (62%) are predominantly orally fed.
With continued experience and technical refinements, the Foker process has evolved with improved outcomes, less morbidity and maximal esophageal preservation.
食管生长采用福克（Foker）过程（FP）治疗长段食管闭锁（LGEA）已经随着时间的推移而发展。
将 2014 年至 2020 年期间治疗的现代 LGEA 患者与历史对照组（2005 年至<2014 年）进行比较。
102 例现代 LGEA 患者（A型 50%，B 型 18%，C 型 32%；36%有先前吻合尝试；20 例有食管造口术）接受了一期修复（n=23）、空肠间置术（JI；n=14）或福克过程（FP；n=65；49 例为一期 [p]，16 例为挽救性 [r]）。与历史上接受 p-FP 治疗的患者（n=27）相比，当代 p-FP 组在牵引时的漏口（4% vs 22%）、骨折（2% vs 22%）、吻合口漏（12% vs 37%）和福克失败（FP→JI；0% vs 15%）明显减少，所有 p 值均<0.01。完全（n=11）或部分（n=11）微创 FP 的患者与开放 FP 患者相比，经历了更少的中位数天的瘫痪（0 天 vs 8 天 vs 17 天）和插管（9 天 vs 15 天 vs 25 天），分别（所有 p 值均<0.03），漏口发生率相当（18% vs 9% vs 26%，p=0.47）。在 FP 后一年，大多数患者（62%）主要经口喂养。
随着经验的不断积累和技术的不断改进，福克过程得到了发展，其结果得到了改善，发病率降低，最大限度地保留了食管。
