Engum S A, Grosfeld J L, West K W, Rescorla F J, Scherer L R
Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
Arch Surg. 1995 May;130(5):502-8; discussion 508-9. doi: 10.1001/archsurg.1995.01430050052008.
This report analyzes the morbidity and mortality in 227 infants (127 boys and 100 girls) with variants of esophageal atresia and/or tracheoesophageal fistula who were treated from 1971 to 1993.
Data were collected retrospectively from hospital and office records. Mean follow-up was 76 months, ranging from 1 month to 22 years.
Patients were treated at a tertiary care children's hospital.
The mean birth weight was 2557 g (range, 1100 to 4460 g), and the mean gestational age was 38 weeks (range, 28 to 42 weeks). Classification included 29 cases of type A esophageal atresia (13%); two cases of type B (1%), 178 cases of type C (78%), five cases of type D (2%), and 13 cases of type E (6%). Associated anomalies occurred in 146 infants (64%), including cardiac defects in 86 (38%), skeletal defects in 44 (19%), neurological defects in 34 (15%), renal defects in 35 (15%), anorectal defects in 18 (8%), and other abnormalities in 30 (13%). A single-layer anastomosis was performed in 81%, and a two-layer repair, in 17%. Esophagomyotomy was necessary in 9% of the patients. Anastomotic complications included leakage (16%), symptomatic stricture (35%), and recurrent tracheoesophageal fistula (3%). Gastroesophageal reflux was present in 127 cases (58%), with 56 (44%) requiring an antireflux procedure. Tracheomalacia occurred in 32 cases (15%), and 13 required operative treatment. Postoperative esophageal dysmotility was documented in 56 children (30%). The overall survival rate was 95%. The cause of death in 12 patients included severe cardiac anomalies (n = 3), fatal sleep apnea (n = 1), renal failure (n = 1), trisomy 18 (n = 2), accidental decannulation of tracheostomy (n = 1), pulmonary failure (n = 1), and unknown causes (n = 3).
Early diagnosis, improved surgical technique, neonatal anesthesia, sophisticated ventilatory support, advanced intensive care management, early treatment of associated anomalies, responsiveness of anastomotic strictures to dilatation, and aggressive treatment of gastroesophageal reflux have influenced survival positively. Improved survival rates were noted irrespective of the traditional Waterston criteria, which now seem outdated. With few exceptions, most infants with esophageal atresia and/or tracheoesophageal fistula should survive in the current era.
本报告分析了1971年至1993年期间接受治疗的227例食管闭锁和/或气管食管瘘变异型婴儿（127例男婴和100例女婴）的发病率和死亡率。
数据从医院和办公室记录中回顾性收集。平均随访时间为76个月，范围从1个月至22年。
患者在一家三级儿童专科医院接受治疗。
平均出生体重为2557克（范围1100至4460克），平均胎龄为38周（范围28至42周）。分类包括29例A型食管闭锁（13%）；2例B型（1%），178例C型（78%），5例D型（2%），13例E型（6%）。146例婴儿（64%）存在相关畸形，包括86例心脏缺陷（38%），44例骨骼缺陷（19%），34例神经缺陷（15%），35例肾脏缺陷（15%），18例肛门直肠缺陷（8%），30例其他异常（13%）。81%进行了单层吻合，17%进行了双层修复。9%的患者需要进行食管肌层切开术。吻合口并发症包括渗漏（16%）、有症状的狭窄（35%）和复发性气管食管瘘（3%）。127例（58%）存在胃食管反流，其中56例（44%）需要进行抗反流手术。32例（15%）发生气管软化，13例需要手术治疗。56例儿童（30%）记录有术后食管运动障碍。总体生存率为95%。12例患者的死亡原因包括严重心脏畸形（n = 3）、致命性睡眠呼吸暂停（n = 1）、肾衰竭（n = 1）、18三体综合征（n = 2）、气管造口意外脱管（n = 1）、肺衰竭（n = 1）以及不明原因（n = 3）。
早期诊断、改进的手术技术、新生儿麻醉、精密的通气支持、先进的重症监护管理、相关畸形的早期治疗、吻合口狭窄对扩张的反应性以及积极治疗胃食管反流对生存产生了积极影响。无论传统的沃斯顿标准如何，生存率均有所提高，该标准现在似乎已过时。除少数例外，大多数食管闭锁和/或气管食管瘘婴儿在当今时代应能存活。
