Outcome in neonates with esophageal atresia treated over the last 20 years
Outcome in neonates with esophageal atresia treated over the last 20 years
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DOI：
10.1007/s00383-008-2122-z
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发表时间：
2008-05-01
影响因子：
1.8
通讯作者：
Wester, Tomas
中科院分区：
文献类型：
--
作者：
Lilja, Helene Engstrand;Wester, Tomas
我们评估了过去二十年来在我科接受治疗的食道闭锁(EA)婴儿的结果。本文回顾了1986~2005年收治的147例婴幼儿的病历资料。记录患者特征、相关异常、手术和并发症。我们将这些资料分为两个时间段：1986-1995年和1996-2005年；125名患者或父母接受了关于胃肠功能、呼吸道症状和教育的访谈。主要心脏缺陷发生率从23%上升到29%，总存活率从87%上升到94%。按Spitz‘s分级，I组生存率由93.5%上升至100%，II组由68.4%上升至77.8%。吻合口漏和复发性瘘的发生率不随时间变化。吻合口狭窄的发生率从53%上升到59%。一期吻合成功率为78%，二期吻合成功率为85%。在这两个时间段，分别只有11%和9%的人进行了抗反流手术。在16-20岁的患者中，40%-50%有胃肠道和呼吸道症状。90%的患者上过师范学校。1986-1995年和1996-2005年期间的主要区别是，尽管主要心脏缺陷的发生率增加，但存活率增加了。胃肠道和呼吸道症状多见。对食道闭锁并发症的长期随访和治疗对这一患者组很重要。
We evaluated the outcome in infants with esophageal atresia (EA) treated in our department over the last two decades. The medical records of 147 infants treated from 1986 to 2005 were reviewed. Patient characteristics, associated anomalies, surgery and complications were recorded. We divided the material into two time-periods: 1986-1995 and 1996-2005; 125 patients or parents were interviewed regarding gastrointestinal function, respiratory symptoms and education. The incidence of major cardiac defects increased from 23 to 29% and the overall survival increased from 87 to 94%. Using Spitz' classification survival increased from 93.5 to 100% in group I and from 68.4 to 77.8% in group II. In group III, during the second time period, survival was 100% in three patients. The incidence of anastomotic leakage and recurrent fistula did not change over time. The rate of anastomotic strictures increased from 53 to 59% between the two time-periods. A primary anastomosis could be done in 85% of the patients during the second period versus 78% of the patients during the first period. Anti-reflux surgery was done in only 11 and 9%, respectively, during the two time-periods. In patients who were 16-20 years old, 40-50% had gastrointestinal and respiratory symptoms. Ninety percent of the patients attended normal school. The major difference between the periods 1986-1995 and 1996-2005 was an increased survival despite an increased incidence of major cardiac defects. Gastrointestinal and respiratory symptoms were frequent. Long-term follow-up and treatment of complications of esophageal atresia is important for this patient group.