Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans St, The Charlotte R. Bloomberg Children's Center, Baltimore, MD 21287, United States.
Department of Otolaryngology, Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287, United States.
J Pediatr Surg. 2021 Dec;56(12):2172-2179. doi: 10.1016/j.jpedsurg.2021.04.006. Epub 2021 Apr 20.
We sought to evaluate the impact of thoracoscopic repair on perioperative outcomes in infants with esophageal atresia and tracheoesophageal fistula (EA/TEF).
The American College of Surgeons National Surgical Quality Improvement Program pediatric database from 2014 to 2018 was queried for all neonates who underwent operative repair of EA/TEF. Operative approach based on intention to treat was correlated with perioperative outcomes, including 30-day postoperative adverse events, in logistic regression models.
Among 855 neonates, initial thoracoscopic repair was performed in 133 (15.6%) cases. Seventy (53%) of these cases were converted to open. Those who underwent thoracoscopic repair were more likely to be full-term (p = 0.03) when compared to those in the open repair group. There were no significant differences in perioperative outcome measures based on surgical approach except for operative time (thoracoscopic: 217 min vs. open: 180 min, p<0.001). A major cardiac comorbidity (OR 1.6, 95% CI 1.2-2.1; p = 0.003) and preoperative ventilator requirement (OR 1.4, 95% CI 1.0-1.9; p = 0.034) were the only risk factors associated with adverse events.
Thoracoscopic neonatal repair of EA/TEF continues to be used sparingly, is associated with high conversion rates, and has similar perioperative outcomes when compared to open repair.
III.
我们旨在评估胸腔镜修复对食管闭锁和气管食管瘘（EA/TEF）婴儿围手术期结局的影响。
我们检索了 2014 年至 2018 年美国外科医师学会国家外科质量改进计划儿科数据库中所有接受 EA/TEF 手术修复的新生儿病例。根据治疗意向，将手术方法与术后 30 天不良事件等围手术期结局相关联，并在逻辑回归模型中进行分析。
在 855 例新生儿中，133 例（15.6%）患儿初始行胸腔镜修复术，其中 70 例（53%）转为开胸手术。与开胸修复组相比，行胸腔镜修复的患儿更有可能为足月儿（p=0.03）。除手术时间外（胸腔镜组：217 分钟 vs. 开胸组：180 分钟，p<0.001），两组患儿围手术期结局指标无显著差异。主要心脏合并症（OR 1.6，95%CI 1.2-2.1；p=0.003）和术前需要呼吸机支持（OR 1.4，95%CI 1.0-1.9；p=0.034）是不良事件的唯一相关危险因素。
胸腔镜治疗新生儿 EA/TEF 仍较少应用，且与开胸手术相比，胸腔镜修复术具有较高的中转开胸率，围手术期结局相似。
III 级。
