先天性食管闭锁胸腔镜手术与开放手术的长期预后：倾向评分重叠加权分析
Long-term outcomes after thoracoscopic versus open surgery for congenital esophageal atresia: propensity-score overlap weighting analysis.
作者信息
Yanagida Yoshitsugu, Aso Shotaro, Fujiogi Michimasa, Morita Kaori, Kutsukake Mai, Takamoto Naohiro, Fushimi Kiyohide, Fujishiro Jun, Yasunaga Hideo
机构信息
Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
出版信息
Pediatr Surg Int. 2025 Jul 22;41(1):222. doi: 10.1007/s00383-025-06135-2.
PURPOSE
Congenital esophageal atresia requires neonatal surgery. Although short- and medium-term outcomes of thoracoscopic and open surgery have been investigated, long-term outcomes remain unclear. This study aimed to compare the long-term outcomes of these approaches using a Japanese national inpatient database.
METHODS
We identified neonates who underwent open or thoracoscopic surgery for congenital esophageal atresia between April 2016 and March 2022. Patients with prior palliative surgery were excluded. Propensity score overlap weighting analyses were used to compare the outcomes between the groups. The primary outcome was the long-term (1 year after definitive surgery) anastomotic strictures. Secondary outcomes included long- and medium-term (within 30 days to 1 year after definitive surgery) gastroesophageal reflux and medium-term anastomotic strictures.
RESULTS
Among 395 patients, 67 underwent thoracoscopic surgery and 328 underwent open surgery. Propensity score overlap weighting analyses revealed no significant differences in long-term anastomotic stricture (5.8% vs. 8.7%; risk difference (RD), - 2.9%; 95% confidence interval (CI), - 10.9 to 5.1), long-term gastroesophageal reflux (2.9% vs. 3.0%; RD, -0.1%; 95% CI - 7.1 to 4.9), medium-term anastomotic stricture (29.4% vs. 18.8%; RD, 10.6%; 95% CI - 2.5 to 23.7), or medium-term gastroesophageal reflux (4.9% vs. 6.0%; RD, - 1.1; 95% CI -7 .1 to 4.9).
CONCLUSIONS
Long-term outcomes did not differ significantly between thoracoscopic and open surgery for congenital esophageal atresia.
目的
先天性食管闭锁需要新生儿手术治疗。虽然已经对胸腔镜手术和开放手术的短期和中期结果进行了研究，但长期结果仍不明确。本研究旨在使用日本全国住院患者数据库比较这两种手术方式的长期结果。
方法
我们确定了2016年4月至2022年3月期间因先天性食管闭锁接受开放手术或胸腔镜手术的新生儿。排除先前接受过姑息手术的患者。采用倾向得分重叠加权分析比较两组的结果。主要结局是长期（确定性手术后1年）吻合口狭窄。次要结局包括长期和中期（确定性手术后30天至1年）胃食管反流和中期吻合口狭窄。
结果
在395例患者中，67例接受了胸腔镜手术，328例接受了开放手术。倾向得分重叠加权分析显示，长期吻合口狭窄（5.8%对8.7%；风险差异（RD），-2.9%；95%置信区间（CI），-10.9至5.1）、长期胃食管反流（2.9%对3.0%；RD，-0.1%；95%CI -7.1至4.9）、中期吻合口狭窄（29.4%对18.8%；RD，10.6%；95%CI -2.5至23.7）或中期胃食管反流（4.9%对6.0%；RD，-1.1；95%CI -7.1至4.9）之间无显著差异。
结论
先天性食管闭锁的胸腔镜手术和开放手术的长期结果无显著差异。
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