大阪地区的食管闭锁：39年经验回顾

Esophageal atresia in Osaka: a review of 39 years' experience.

作者信息

Okada A, Usui N, Inoue M, Kawahara H, Kubota A, Imura K, Kamata S

机构信息

The Department of Pediatric Surgery, Osaka University Medical School and Osaka Prefectural Medical and Research Institute for Mother and Child Health, Suita, Japan.

出版信息

J Pediatr Surg. 1997 Nov;32(11):1570-4. doi: 10.1016/s0022-3468(97)90455-3.

DOI:10.1016/s0022-3468(97)90455-3

PMID:9396528

Abstract

BACKGROUND

One hundred fifty-nine patients who had esophageal atresia with or without tracheoesophageal fistula have been treated at Osaka University Medical School and its affiliated hospitals since the initial (Japanese) experience of Dr T. Ueda in 1957.

METHODS

These cases were divided chronologically into three groups. With earlier recognition of surgical neonates and the development of perinatal care, the long-term survival of these patients has steadily improved over 39 years from 28% in the first period (1957 to 1967) to 80% in the third period (1980 to 1995). Of 141 patients treated in the second and third periods (1968 to 1995), 92 (65.2%) had associated anomalies. Cardiovascular and gastrointestinal malformations were the most frequently seen major anomalies. VATER or VACTER association was seen in 12.8% (18 of 141) of these patients. Survival of these cases according to Waterston risk factors was 100% for group A, 100% for group B, and 50% for group C, whereas the new classification proposed by Spitz showed survival of 92% for group 1, 50% for group 2, and 0% for group 3, showing better differentiation among the three groups.

RESULTS

There was a long gap between the proximal and distal esophageal ends in seven patients (type A), in all of whom primary anastomosis was possible after 28 to 128 days of elongation by bouginage. Although the survival of esophageal atresia patients dramatically improved in recent years, there is still a high incidence of early and long-term postoperative complications, ie, anastomotic leakage (26.5%), recurrent fistula (7.2%), anastomotic stricture (49.1%), postoperative pneumonia or atelectasis (57.0%), tracheomalacia (25.8%), and gastroesophageal reflux (52.0%).

CONCLUSIONS

Recently, there have been changing patterns in the occurrence of complications, which are mainly attributed to technical improvement, better perinatal care and early recognition of pathophysiologic conditions such as tracheomalacia and gastroesophageal reflux.

摘要

背景

自1957年上田博士在日本开展首例食管闭锁合并或不合并气管食管瘘手术以来，大阪大学医学院及其附属医院共收治了159例此类患者。

方法

这些病例按时间顺序分为三组。随着对手术新生儿的早期识别以及围产期护理的发展，这些患者的长期生存率在39年中稳步提高，从第一阶段（1957年至1967年）的28%提高到第三阶段（1980年至1995年）的80%。在第二和第三阶段（1968年至1995年）接受治疗的141例患者中，92例（65.2%）伴有其他畸形。心血管和胃肠道畸形是最常见的主要畸形。这些患者中12.8%（141例中的18例）出现VATER或VACTER联合畸形。根据沃特斯顿风险因素，A组患者的生存率为100%，B组为100%，C组为50%；而斯皮茨提出的新分类显示，1组患者的生存率为92%，2组为50%，3组为0%，三组之间的区分度更好。

结果

7例患者（A型）的食管近端和远端之间存在较长间隙，所有这些患者在通过探条扩张延长28至128天后均可行一期吻合术。尽管近年来食管闭锁患者的生存率显著提高，但术后早期和长期并发症的发生率仍然很高，即吻合口漏（26.5%）、复发性瘘（7.2%）、吻合口狭窄（49.1%）、术后肺炎或肺不张（57.0%）、气管软化（25.8%）和胃食管反流（52.0%）。