Teich S, Barton D P, Ginn-Pease M E, King D R
Department of Surgery, Children's Hospital, Columbus, OH, USA.
J Pediatr Surg. 1997 Jul;32(7):1075-9; discussion 1079-80. doi: 10.1016/s0022-3468(97)90402-4.
Since 1962, the Waterston classification has been used to stratify neonates who have esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) into prognostic categories based on birth weight, the presence of pneumonia, and the identification of other congenital anomalies. In response to advances in neonatal care, the surgeons from the Montreal Children's Hospital proposed a new categorization system in 1993 in an attempt to define the current risk factors for patients who have EA/TEF. In the Montreal experience only two characteristics independently affected survival: preoperative ventilator dependence and associated major anomalies. The goal of this study was to determine which system had the greatest validity for the evaluation of prognosis in our patients with EA/TEF. The charts of 94 patients who had EA/TEF treated between 1972 and 1991 were reviewed. Patients were classified using both the Waterston and Montreal systems. Groups were compared with Fisher's Exact test using a 95% confidence level for statistical significance. Eleven infants were ventilator dependent preoperatively; 62 children had major associated anomalies, 8 of which were considered life threatening. Sixteen children died within 4 years, eight during their initial hospital stay. Five of the eight early postoperative deaths occurred in the highest-risk patients (Waterston C or Montreal II). Analysis was performed for multiple risk factors and mortality. As in the Montreal study, the presence of life-threatening and major congenital anomalies represented significant risk factors for death. Pulmonary disease as delineated by ventilator dependence appeared to be more accurate than pneumonia. This study confirms the accuracy of the Montreal classification in defining prognosis for EA/TEF. The Montreal system more accurately identifies children at highest risk than the Waterston classification.
自1962年以来，沃斯顿分类法一直被用于根据出生体重、是否存在肺炎以及其他先天性异常的识别情况，将患有食管闭锁（EA）和/或气管食管瘘（TEF）的新生儿分层到不同的预后类别中。为应对新生儿护理方面的进展，蒙特利尔儿童医院的外科医生于1993年提出了一种新的分类系统，试图确定患有EA/TEF患者当前的风险因素。在蒙特利尔的经验中，仅有两个特征独立影响生存率：术前对呼吸机的依赖以及相关的主要异常。本研究的目的是确定哪种系统在评估我们的EA/TEF患者预后方面具有最大的有效性。回顾了1972年至1991年间接受治疗的94例EA/TEF患者的病历。使用沃斯顿和蒙特利尔系统对患者进行分类。采用费舍尔精确检验对组间进行比较，设定95%的置信水平以确定统计学意义。11例婴儿术前依赖呼吸机；62例儿童有主要相关异常，其中8例被认为危及生命。16例儿童在4年内死亡，8例在其首次住院期间死亡。8例术后早期死亡中有5例发生在风险最高的患者中（沃斯顿C级或蒙特利尔II级）。对多种风险因素和死亡率进行了分析。与蒙特利尔的研究一样，存在危及生命的主要先天性异常是死亡的重要风险因素。呼吸机依赖所界定的肺部疾病似乎比肺炎更准确。本研究证实了蒙特利尔分类法在定义EA/TEF预后方面的准确性。与沃斯顿分类法相比，蒙特利尔系统能更准确地识别出风险最高的儿童。
