长段食管闭锁：胃移位还是食管延长加延迟一期吻合？系统评价。
Long-gap esophageal atresia: gastric transposition or esophageal lengthening with delayed primary anastomosis? A systematic review.
机构信息
Department of Continuing Education, University of Oxford, Oxford, UK.
Pediatric Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
出版信息
Pediatr Surg Int. 2024 Apr 24;40(1):112. doi: 10.1007/s00383-024-05695-z.
PURPOSE
This study aims to evaluate different surgical approaches to long-gap esophageal atresia (LGEA) with or without tracheoesophageal fistula (TEF) is unclear.
METHODS
A systematic literature review was done comparing gastric transposition versus esophageal lengthening with delayed primary anastomosis in infants with LGEA+/-TEF. The primary outcome was time to full oral feeds. Secondary outcomes were time to full enteric feeds, need for further surgery, growth, mortality, and postoperative adverse events.
RESULTS
No comparative studies were found. However, the literature was re-interrogated for non-comparative studies. Four hundred thirty-eight articles were identified and screened, and 18 met the inclusion criteria. All were case series. Forty-three infants underwent gastric transposition, and 106 had esophageal lengthening with delayed primary anastomosis. One study on gastric transposition reported time to full oral feeds, and one study in each group reported growth. Time to full enteric feeds was reported in one study in each group. 30% of infants had further surgery following gastric transposition, including hiatus hernia repair (5/43, 12%) and esophageal dilation (7/43, 16%). Following esophageal lengthening, 62/106 (58%) had anti-reflux surgery, 58/106 (55%) esophageal dilatation and 11/106 (10%) esophageal stricture resection. Anastomotic complications occurred in 13/43 (30%), gastrointestinal in 16/43 (37%), respiratory in 17/43 (40%), and nerve injury in 2/43 (5%) of the gastric transposition group. In the esophageal lengthening group, anastomotic complications occurred in 68/106 (64%), gastrointestinal in 62/106 (58%), respiratory in 6/106 (6%), and none sustained nerve injury. Each group had one death due to a cause not directly related to the surgical procedure.
CONCLUSIONS
This systematic review highlights the morbidity associated with both surgical procedures and the variety in reporting outcomes.
目的
本研究旨在评估伴有或不伴有气管食管瘘（TEF）的长段食管闭锁（LGEA）的不同手术方法。
方法
系统地对胃移位与食管延长加延迟一期吻合术治疗 LGEA+/-TEF 婴儿的文献进行比较。主要结果是完全口服喂养的时间。次要结果是完全肠内喂养的时间、需要进一步手术、生长、死亡率和术后不良事件。
结果
未发现比较研究。然而，对非比较研究的文献进行了重新审查。共确定了 438 篇文章并进行了筛选，其中 18 篇符合纳入标准。所有研究均为病例系列研究。43 例婴儿行胃移位，106 例行食管延长加延迟一期吻合术。一项胃移位的研究报告了完全口服喂养的时间，两组中的一项研究报告了生长情况。两组中的一项研究报告了完全肠内喂养的时间。胃移位后有 30%的婴儿需要进一步手术，包括膈疝修补术（5/43，12%）和食管扩张术（7/43，16%）。食管延长后，62/106（58%）行抗反流手术，58/106（55%）行食管扩张术，11/106（10%）行食管狭窄切除术。胃移位组吻合口并发症 13 例（30%），胃肠道并发症 16 例（37%），呼吸系统并发症 17 例（40%），神经损伤 2 例（5%）。食管延长组吻合口并发症 68 例（64%），胃肠道并发症 62 例（58%），呼吸系统并发症 6 例（6%），无神经损伤。每组均有 1 例死亡，与手术过程无关。
结论
本系统评价强调了两种手术方法相关的发病率以及报告结果的多样性。
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