Poenaru D, Laberge J M, Neilson I R, Guttman F M
Department of General Surgery, Montreal Children's Hospital, McGill University, Quebec, Canada.
Surgery. 1993 Apr;113(4):426-32.
Waterston's risk categories have been extensively used in the past for the classification and management of neonates with esophageal atresia. Advances in neonatal care have affected the prognostic usefulness of the Waterston classification. The purpose of this study is to formulate a new classification of risk factors that would more accurately predict outcome.
We retrospectively reviewed 95 consecutive cases of esophageal atresia and/or tracheoesophageal fistula treated at the Montreal Children's Hospital. Fifteen patients were in the Waterston class A, with a 6.7% mortality; 35 patients, in class B with a 5.7% mortality; and 45 patients, in class C with a 26.7% mortality. Logistic regression analysis of the influence of each risk factor (weight, pulmonary status, and severity of associated anomalies) on mortality was performed.
Birth weight was not found to independently influence mortality. Only severe pulmonary dysfunction with preoperative ventilator dependence and severe associated anomalies had a prognostic influence. We therefore revised the classification to include only significant factors. The new high-risk class II consists of patients with either life-threatening anomalies or both major anomalies and ventilator dependence; the low-risk class I includes all other patients. These criteria radically changed the stratification of both the number of cases and the mortality among classes: the 82 patients in class I had a 7.3% mortality; the 13 patients in class II had a 69.2% mortality. Logistic regression analysis confirmed the validity of this new classification by showing displacement of individual variables by the revised classification but not by Waterston's.
This new "Montreal classification" can simplify and improve the stratification of patients with esophageal atresia. It also reflects the more favorable outcome of low birth weight neonates.
过去，沃斯顿风险分类法被广泛用于食管闭锁新生儿的分类和管理。新生儿护理的进展影响了沃斯顿分类法在预后方面的实用性。本研究的目的是制定一种新的风险因素分类法，以更准确地预测预后。
我们回顾性分析了蒙特利尔儿童医院连续收治的95例食管闭锁和/或气管食管瘘病例。15例患者属于沃斯顿A类，死亡率为6.7%；35例患者属于B类，死亡率为5.7%；45例患者属于C类，死亡率为26.7%。对每个风险因素（体重、肺部状况和相关畸形的严重程度）对死亡率的影响进行了逻辑回归分析。
未发现出生体重对死亡率有独立影响。只有术前依赖呼吸机的严重肺功能障碍和严重相关畸形对预后有影响。因此，我们修订了分类法，只纳入显著因素。新的高危II类包括有危及生命的畸形或同时有主要畸形和呼吸机依赖的患者；低危I类包括所有其他患者。这些标准从根本上改变了各类病例数和死亡率的分层：I类的82例患者死亡率为7.3%；II类的13例患者死亡率为69.2%。逻辑回归分析证实了这种新分类法的有效性，因为修订后的分类法显示了各个变量的变化，而沃斯顿分类法则没有。
这种新的“蒙特利尔分类法”可以简化并改进食管闭锁患者的分层。它还反映了低出生体重新生儿更有利的预后。
