Ure B M, Slany E, Eypasch E P, Gharib M, Holschneider A M, Troidl H
Department of Paediatric Surgery, Children's Hospital of Cologne, Germany.
Eur J Pediatr Surg. 1995 Aug;5(4):206-10. doi: 10.1055/s-2008-1066206.
Out of a series of 146 patients with oesophageal atresia 9 (6.2%) underwent colon interposition from 1963 to 1971. All eight surviving patients were seen at follow-up after a mean of 22 years. Three patients were free of specific symptoms according to the criteria of DeMeester, two had moderate and three severe distress. The mean time for consuming a standardized test meal was 15 minutes, compared to 8 minutes in healthy controls. Patients required 1-9 minutes to transport liquid barium through the transplant, compared to < 10 seconds in control subjects. Histological evaluation revealed a normal architecture of the colonic and ileal epithelium in three patients who underwent endoscopy. In none of these patients were contractions in the colon graft related to the act of swallowing recorded on manometry. Unimpaired quality of life was indicated by the Spitzer index which scored a mean of nine out of ten points. However, on a 100point visual analogue scale patients scored their global quality of life 66 and the mean Gastrointestinal Quality of Life Index was 92.2, compared to 107.6 in healthy control subjects (p < 0.05). This impairment was exclusively due to specific symptoms which scored 49.3 in patients and 59 in healthy individuals (p < 0.05). Physical and social functions, emotions, and inconvenience of a medical treatment were similar to control subjects. We conclude that colon interposition for long-gap oesophageal atresia achieves acceptable long-term functional results. However, specific symptoms lead to a considerable impairment in quality of life.
在1963年至1971年间，146例食管闭锁患者中有9例（6.2%）接受了结肠间置术。8例存活患者在平均22年的随访期内接受了检查。根据DeMeester标准，3例患者无特定症状，2例有中度不适，3例有重度不适。食用标准化测试餐的平均时间为15分钟，而健康对照组为8分钟。患者需要1至9分钟才能使液体钡剂通过移植段，而对照组受试者则不到10秒。组织学评估显示，3例接受内镜检查的患者结肠和回肠上皮结构正常。在这些患者中，测压均未记录到结肠移植物的收缩与吞咽动作有关。Spitzer指数显示生活质量未受损害，平均得分为十分制中的9分。然而，在100分的视觉模拟量表上，患者对整体生活质量的评分是66分，胃肠道生活质量指数平均为92.2分，而健康对照组为107.6分（p<0.05）。这种损害完全是由于特定症状导致的，患者的特定症状评分为49.3分，健康个体为59分（p<0.05）。身体和社会功能、情绪以及医疗不便程度与对照组相似。我们得出结论，结肠间置术治疗长段食管闭锁可取得可接受的长期功能结果。然而，特定症状会导致生活质量受到相当大的损害。
