Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
Department of Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
J Pediatr Surg. 2023 Dec;58(12):2375-2383. doi: 10.1016/j.jpedsurg.2023.07.014. Epub 2023 Jul 29.
Anastomotic strictures (AS) after esophageal atresia (EA) repair are common. While most respond to endoscopic therapy, some become refractory and require surgical intervention, for which the outcomes are not well established.
All EA children with AS who were treated surgically at two institutions (2011-2022) were retrospectively reviewed. Surgical repair was performed for those with AS that were either refractory to endoscopic therapy or clinically symptomatic and undergoing surgery for another indication. Anastomotic leak, need for repeat stricture resection, and esophageal replacement were considered poor outcomes.
139 patients (median age: 12 months, range 1.5 months-20 years; median weight: 8.1 kg) underwent 148 anastomotic stricture repairs (100 refractory, 48 non-refractory) in the form of stricturoplasty (n = 43), segmental stricture resection with primary anastomosis (n = 96), or stricture resection with a delayed anastomosis after traction-induced lengthening (n = 9). With a median follow-up of 38 months, most children (92%) preserved their esophagus, and the majority (83%) of stricture repairs were free of poor outcomes. Only one anastomotic leak occurred in a non-refractory stricture. Of the refractory stricture repairs (n = 100), 10% developed a leak, 9% required repeat stricture resection, and 13% required esophageal replacement. On multivariable analysis, significant risk factors for any type of poor outcome included anastomotic leak, stricture length, hiatal hernia, and patient's weight.
Surgery for refractory AS is associated with inherent yet low morbidity and high rates of esophageal preservation. Surgical repair of non-refractory symptomatic AS at the time of another thoracic operation is associated with excellent outcomes.
Level III.
食管闭锁（EA）修复术后吻合口狭窄（AS）较为常见。大多数患者对内镜治疗有反应，但有些患者会出现难治性狭窄，需要手术干预，其结果尚未明确。
回顾性分析了在两个机构（2011-2022 年）接受手术治疗的所有 EA 患儿的 AS 病例。对那些对内镜治疗有抵抗性或有临床症状且因其他指征而接受手术的患者进行手术修复。吻合口漏、需要再次进行狭窄切除术和食管置换被认为是不良结局。
139 例患儿（中位年龄：12 个月，范围 1.5 个月至 20 岁；中位体重：8.1kg）接受了 148 次吻合口狭窄修复术（100 例难治性，48 例非难治性），其中包括狭窄成形术（n=43）、节段性狭窄切除术伴一期吻合术（n=96）或狭窄切除术伴牵引延长后的延迟吻合术（n=9）。中位随访 38 个月后，大多数患儿（92%）保留了食管，且大多数（83%）狭窄修复术无不良结局。只有 1 例非难治性狭窄发生吻合口漏。在难治性狭窄修复术（n=100）中，10%发生漏口，9%需要再次进行狭窄切除术，13%需要食管置换。多变量分析显示，任何类型不良结局的显著危险因素包括吻合口漏、狭窄长度、食管裂孔疝和患者体重。
难治性 AS 的手术治疗存在固有但较低的发病率和较高的食管保留率。在进行另一种胸部手术时，对有症状的非难治性 AS 进行手术修复，可获得良好的结果。
III 级。
