Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula - A multi-institutional analysis
Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula - A multi-institutional analysis
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DOI：
10.1097/01.sla.0000179649.15576.db
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发表时间：
2005-09-01
影响因子：
9
通讯作者：
Yeung, CK
中科院分区：
文献类型：
--
作者：
Holcomb, GW;Rothenberg, SS;Yeung, CK
目的：在过去的60年里，成功的修复食管闭锁（EA）和远端气管食管瘘（TEF）已通过开胸手术。然而，一些报告描述了婴幼儿开胸术后的不良肌肉骨骼后遗症。到目前为止，只有少数零散的病例报告详细介绍了个别外科医生成功的胸腔镜修复EA/TEF。这种多机构的审查代表了最大的经验，描述了结果与此approach.Methods：一个队列的国际小儿外科医生进行先进的腹腔镜和胸腔镜手术的婴儿和儿童中心回顾性审查了他们的数据，在104个新生儿EA/TEF的初级胸腔镜修复。排除伴有EA但无远端TEF或伴有孤立性TEF但无EA的新生儿。在这104例患者中，手术时的平均年龄为1.2天（+/- 1.1），平均体重为2.6 kg（+/- 0.5），平均手术时间为129.9分钟平均机械通气天数为3.6（+/-5.8），平均总住院天数为18.1（+/- 18.6）。12名（11.5%）婴儿在吻合口处发生早期泄漏或狭窄，33名（31.7%）婴儿至少需要一次食管扩张。5例手术（4.8%）转为开胸手术，1例因2个食管段之间的间隙较长而分期。25名新生儿（24.0%）后来需要腹腔镜胃底折叠术。2例（1.9%）婴儿出现食管和气管之间的复发性瘘。这些患者还需要进行其他手术，包括10例患者（7例高位，3例低位）的直肠肛门修复术、直肠固定术（7例）、腹腔镜十二指肠闭锁修复术（4例）和各种大型心脏手术（5例）。三例患者死亡，一个相关的EA/TEF在术后第20天day.Conclusions：胸腔镜下修复EA/TEF代表了一个自然的演变，在手术纠正这种复杂的先天性异常，可以安全地进行经验丰富的内窥镜外科医生。本研究的结果与以前报道的婴儿通过开胸手术进行修复的结果相当。基于开胸术后相关的肌肉骨骼问题，胸腔镜修复术可能会对患有这种异常的婴儿产生长期益处。
Objectives: For the past 60 years, successful repair of esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) has been performed via a thoracotomy. However, a number of reports have described adverse musculoskeletal sequelae following thoracotomy in infants and young children. Until now, only a few scattered case reports have detailed an individual surgeon's success with thoracoscopic repair of EA/TEF. This multi-institutional review represents the largest experience describing the results with this approach.Methods: A cohort of international pediatric surgeons from centers that perform advanced laparoscopic and thoracoscopic operations in infants and children retrospectively reviewed their data on primary thoracoscopic repair in 104 newborns with EA/TEF. Newborns with EA without a distal TEF or those with an isolated TEF without EA were excluded.Results: In these 104 patients, the mean age at operation was 1.2 days (+/- 1.1), the mean weight was 2.6 kg (+/- 0.5), the mean operative time was 129.9 minutes (+/- 55.5), the mean days of mechanical ventilation were 3.6 (+/- 5.8), and the mean days of total hospitalization were 18.1 (+/- 18.6). Twelve (11.5%) infants developed an early leak or stricture at the anastomosis and 33 (31.7%) required esophageal dilatation at least once. Five operations (4.8%) were converted to an open thoracotomy and one was staged due to a long gap between the 2 esophageal segments. Twenty-five newborns (24.0%) later required a laparoscopic fundoplication. A recurrent fistula between the esophagus and trachea developed in 2 infants (1.9%). A number of other operations were required in these patients, including imperforate anus repair in 10 patients (7 high, 3 low), aortopexy (7), laparoscopic duodenal atresia repair (4), and various major cardiac operations (5). Three patients died, one related to the EA/TEF on the 20th postoperative day.Conclusions: The thoracoscopic repair of EA/TEF represents a natural evolution in the operative correction of this complicated congenital anomaly and can be safely performed by experienced endoscopic surgeons. The results presented are comparable to previous reports of babies undergoing repair through a thoracotomy. Based on the associated musculoskeletal problems following thoracotomy, there will likely be long-term benefits for babies with this anomaly undergoing the thoracoscopic repair.