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. 2024 Dec;59(12):161628. doi: 10.1016/j.jpedsurg.2024.07.013. Epub 2024 Jul 16.
The traction-induced esophageal growth (Foker) process for the treatment of long gap esophageal atresia (LGEA) relies on applying progressive tension to the esophagus to induce growth. Due to its anti-fibrotic and muscle-relaxing properties, we hypothesize that Botulinum Toxin A (BTX) can enhance traction-induced esophageal growth.
A retrospective two-center cohort study was conducted on children who underwent a BTX-enhanced Foker process for LGEA repair from 2021 to 2023. BTX (10 units/ml, 2 units/kg, per esophageal pouch) was applied at the time of traction initiation. Time on traction, complications, and anastomotic outcomes were compared against historical controls (Foker process without BTX) from 2014 to 2021.
Twenty infants (LGEA type A:12, B:4, C:4; 35% reoperative; median [IQR] age 3 [2-5] months), underwent BTX-enhanced Foker process (thoracotomy with external traction: 9; minimally invasive [MIS] multi-staged internal traction: 11). Mean gap lengths were similar between BTX-enhanced external and external traction control patients (mean [SD], 50.6 mm [12.6] vs. 44.5 mm [11.9], p = 0.21). When compared to controls, the BTX-enhanced external traction process was significantly faster (mean [SD], 12.1 [1.6] days vs. 16.6 [13.2] without BTX, p = 0.04) despite similar preoperative gap lengths. There was no difference in time on traction for those undergoing a minimally invasive process. There were no significant differences in complications or anastomotic outcomes in either cohort.
Botulinum toxin may play a role in accelerating the traction-induced esophageal growth process for LGEA repair. Minimizing time on traction can decrease sedation and paralysis burden while on external traction. Further studies are needed to elucidate the effects of BTX on the esophagus.
Level III.
Retrospective, Two-center, Cohort study.
为治疗长段食管闭锁（LGEA），采用牵引诱导食管生长（Foker）的方法，通过对食管施加逐渐增加的张力，刺激食管生长。肉毒毒素 A（BTX）具有抗纤维化和肌肉松弛的特性，我们推测其可以增强牵引诱导的食管生长。
对 2021 年至 2023 年期间因 LGEA 修复而接受 BTX 增强 Foker 手术的患儿进行了一项回顾性的双中心队列研究。在开始牵引时，每个食管囊注射 BTX（10 单位/ml，每公斤 2 单位）。比较了接受 BTX 增强 Foker 手术（开胸术加外部牵引：9 例；微创[MIS]多阶段内部牵引：11 例）的患儿与 2014 年至 2021 年期间接受单纯 Foker 手术（无 BTX）患儿的牵引时间、并发症和吻合口结果。
共 20 例婴儿（LGEA 型 A：12 例，B：4 例，C：4 例；35%为再次手术；中位[IQR]年龄 3[2-5]个月）接受了 BTX 增强 Foker 手术（开胸术加外部牵引：9 例；微创[MIS]多阶段内部牵引：11 例）。BTX 增强的外部牵引组与外部牵引对照组的平均间隙长度相似（平均[SD]，50.6[12.6]mm 与 44.5[11.9]mm，p=0.21）。与对照组相比，BTX 增强的外部牵引过程明显更快（平均[SD]，12.1[1.6]天与无 BTX 的 16.6[13.2]天，p=0.04），尽管术前间隙长度相似。微创组的牵引时间无差异。两组患儿的并发症或吻合口结果均无显著差异。
肉毒毒素可能在加速 LGEA 修复的牵引诱导食管生长过程中发挥作用。缩短牵引时间可以减少外部牵引时的镇静和麻痹负担。需要进一步研究来阐明 BTX 对食管的影响。
III 级
回顾性、双中心、队列研究
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