Aubert Ophelia, Lacher Martin, Mayer Steffi, Frahm Jens, Voit Dirk, Rosolowski Maciej, Widenmann Anke, Hirsch Franz W, Gräfe Daniel
Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany.
Biomedical NMR, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany.
Ann Surg. 2025 Jul 1;282(1):70-76. doi: 10.1097/SLA.0000000000006193. Epub 2024 Feb 8.
This study aims to assess morphologic and functional postoperative changes after open or minimally invasive (MIS) repair of esophageal atresia (EA) compared with healthy controls by thoracic real-time magnetic resonance imaging (MRI).
Musculoskeletal deformities and pulmonary morbidity are common in children after EA repair. The real-time MRI is a novel technique that provides ultrafast, high-quality images during spontaneous breathing, without sedation, even in young children.
Children aged 3 to 18 years were prospectively examined with a 3 Tesla MRI. Musculoskeletal deformities, static thoracic cross-sectional areas (CSAs) at 3 different levels and lung volumes, as well as dynamic right-to-left ratio of CSA of hemithoraces and lung volumes during forced breathing were evaluated.
Seventy-two children (42 open, 8 MIS, 22 controls) were recruited. In the EA group, rib fusions and adhesions (78%, P <0.01) and scoliosis (15%, P =0.32) were found after thoracotomy but not after MIS. The mean right-to-left ratio of CSA and lung volumes were lower after EA repair compared with controls ( P <0.05), indicating impaired thoracic and lung development. The number of thoracotomies was a significant risk factor for smaller thoracic volumes ( P <0.05).
For the first time, morphologic changes and thoracic motility after EA repair were visualized by dynamic real-time MRI. After EA repair, children show decreased right-sided thoracic and lung development compared with controls. Open repair leads to significantly more musculoskeletal deformities. This study emphasizes that musculoskeletal morbidity following a thoracotomy in infancy is high.
本研究旨在通过胸部实时磁共振成像（MRI）评估食管闭锁（EA）开放或微创（MIS）修复术后与健康对照相比的形态学和功能学术后变化。
EA修复术后儿童中肌肉骨骼畸形和肺部疾病很常见。实时MRI是一种新技术，即使在幼儿中也能在自然呼吸期间提供超快速、高质量的图像，无需镇静。
对3至18岁的儿童进行前瞻性3特斯拉MRI检查。评估肌肉骨骼畸形、3个不同水平的静态胸部横截面积（CSA）和肺容积，以及用力呼吸期间半侧胸廓CSA和肺容积的动态左右比率。
招募了72名儿童（42名开放手术，8名MIS手术，22名对照）。在EA组中，开胸术后发现肋骨融合和粘连（78%，P<0.01）和脊柱侧弯（15%，P = 0.32），但MIS术后未发现。与对照组相比，EA修复术后CSA和肺容积的平均左右比率较低（P<0.05），表明胸廓和肺发育受损。开胸手术次数是胸廓容积较小的显著危险因素（P<0.05）。
首次通过动态实时MRI观察到EA修复术后的形态学变化和胸廓运动。与对照组相比，EA修复术后儿童右侧胸廓和肺发育减少。开放修复导致明显更多的肌肉骨骼畸形。本研究强调婴儿期开胸术后肌肉骨骼疾病发生率很高。
