Galazka Przemyslaw, Skinder Dominika, Styczynski Jan
Department of General and Oncologic Surgery for Children and Adolescents, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland.
Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland.
Front Surg. 2022 Nov 23;9:1009448. doi: 10.3389/fsurg.2022.1009448. eCollection 2022.
The frequency rate of esophageal anastomosis leaks after thoracoscopic correction of esophageal atresia (EA) in the current literature is reported as 5.6%-24.7% and a conversion rate of 2%-53%. The objective of this retrospective study was to examine the characteristics of EA and analysis of the safety and efficacy of EA repair with the use of the thoracoscopic approach in a single academic center, as well as risk factors analysis in the context of short-term and mid-term follow-up status. A retrospective analysis of the management of all consecutive newborns affected by EA hospitalized in our department over a period between 2013 and 2022, including preoperative, perioperative, and postoperative management, together with the outcome, complications and long-term follow-up status was performed. A total of 38 patients with a median birth weight of 2,570 g (range; 1,020-3,880) were treated over the study period, including 30/38 (78.9%) with additional congenital anomalies. Overall, 30 patients underwent primary anastomosis of the esophagus and eight underwent a multistaged procedure, with or without an initial ligation of the tracheoesophageal fistula and delayed primary anastomosis. Overall survival for all patients was 0.894 ± 0.050, with a median follow-up of 4.5 years. We noted neither anastomotic leaks nor conversions to open technique in our cohort. Implementation of vancomycin prophylaxis was successful in preventing postoperative central venous access-related infectious complications. At the end of the follow-up, 85% of patients have a Lansky performance score ≥80. Risk factors analysis for length of hospitalization, overall survival, Lansky performance status, and neurological impairment were analyzed. In conclusion, we have found that the outcome of thoracoscopic repair of EA in terms of surgery-dependent morbidity (anastomosis leakage, conversion rate to open surgery), provides benefit to those previously reported in the literature, regardless of the prognostic criteria of the classification system.
目前文献报道，胸腔镜矫正食管闭锁（EA）术后食管吻合口漏的发生率为5.6%-24.7%，中转开腹率为2%-53%。本回顾性研究的目的是在单一学术中心探讨EA的特征，分析胸腔镜手术修复EA的安全性和有效性，以及在短期和中期随访情况下的危险因素分析。对2013年至2022年期间在我科住院的所有连续性EA新生儿的治疗情况进行回顾性分析，包括术前、围手术期和术后管理，以及结局、并发症和长期随访情况。在研究期间共治疗了38例患者，中位出生体重为2570g（范围：1020-3880g），其中30/38（78.9%）伴有其他先天性畸形。总体而言，30例患者接受了食管一期吻合，8例接受了多阶段手术，包括或不包括最初结扎气管食管瘘和延迟一期吻合。所有患者的总体生存率为0.894±0.050，中位随访时间为4.5年。我们的队列中未发现吻合口漏或中转开腹情况。万古霉素预防措施成功预防了术后中心静脉置管相关的感染并发症。随访结束时，85%的患者Lansky功能评分≥80分。分析了住院时间、总体生存率、Lansky功能状态和神经功能障碍的危险因素。总之，我们发现，胸腔镜修复EA在手术相关并发症（吻合口漏、中转开腹率）方面的结局优于文献中先前报道的结果，无论分类系统的预后标准如何。
