Spitz L, Kiely E, Brereton R J
J Pediatr Surg. 1987 Feb;22(2):103-8. doi: 10.1016/s0022-3468(87)80420-7.
One hundred forty-eight infants with abnormalities of the esophagus treated over a 5-year period were reviewed: 87% comprised esophageal atresia with distal tracheoesophageal fistula. The survival rate for infants in risk group A was 100%, for risk group B, 86%, and for risk group C, 73%. There were six infants with associated anomalies incompatible with survival. Anastomotic leaks occurred in 21% of cases, strictures in 18% and recurrent tracheoesophageal fistula in 12%. The use of braided silk for the repair was associated with a high complication rate. There was a distinct advantage in delaying surgery pending improvement in aspiration pneumonia. Low birth weight was not considered a contraindication for primary repair. Emergency ligation of the fistula was considered a more appropriate procedure than gastrostomy for the infant with associated severe respiratory distress syndrome in whom mechanical ventilation was providing difficult. Congenital cardiac anomalies were the single most common cause of mortality and correction of these anomalies should be pursued aggressively. There were definite advantages of preoperative endoscopy, particularly in identifying proximal fistulae. Elective postoperative ventilatory support for infants with a very tense anastomosis was successful in preventing leaks in five infants. There were no advantages to routine gastrostomy. Severe gastroesophageal reflux and tracheomalacia demand aggressive management. Mortality was directly related to the severity of associated congenital anomalies.
回顾了在5年期间接受治疗的148例食管异常婴儿：87%为食管闭锁合并远端气管食管瘘。A风险组婴儿的存活率为100%，B风险组为86%，C风险组为73%。有6例婴儿伴有与生存不相容的相关畸形。吻合口漏发生率为21%，狭窄发生率为18%，复发性气管食管瘘发生率为12%。使用编织丝线进行修复与高并发症发生率相关。在吸入性肺炎改善之前延迟手术有明显优势。低出生体重不被视为一期修复的禁忌证。对于伴有严重呼吸窘迫综合征且机械通气困难的婴儿，紧急结扎瘘管被认为比胃造口术更合适。先天性心脏畸形是最常见的单一死亡原因，应积极进行这些畸形的矫正。术前内镜检查有明确优势，特别是在识别近端瘘管方面。对吻合口非常紧张的婴儿进行选择性术后通气支持成功预防了5例婴儿的吻合口漏。常规胃造口术没有优势。严重胃食管反流和气管软化需要积极处理。死亡率与相关先天性畸形的严重程度直接相关。
