Thoracoscopic Stage Internal Traction Repair Reduces Time to Achieve Esophageal Continuity in Long Gap Esophageal Atresia.
Thoracoscopic Stage Internal Traction Repair Reduces Time to Achieve Esophageal Continuity in Long Gap Esophageal Atresia.
复制标题
胸腔镜阶段内牵引修复可缩短长间隙食管闭锁实现食管连续性的时间。
DOI：
10.1055/a-2235-8766
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Borselle D
中科院分区：
文献类型：
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作者：
Borselle D
长间隙食管闭锁（LGOA）的治疗存在争议。本研究旨在比较两个高容量centers.MethodsWe包括LGOA（A型和B）在2008年和2022年之间的患者LGOA的管理。人口统计学，手术方法和结果进行了收集和compared.ResultsThe研究人群涉及28例患者在中心A和24例患者在中心B。A中心采用胸腔镜手术入路，仅1例患者开放进行最终手术。B中心3例仅行胸腔镜手术，2例中转开放手术，19例开放手术。A中心一期食管吻合术1例，二期食管外牵引延长术1例，多期内牵引延长术26例。在24例患者中实现了完全吻合：在23例患者中仅使用内牵引技术，而1例患者需要开放式Collis-Nissen手术作为最终管理。B中心行一期食管吻合7例，延期食管吻合8例，食管外牵引延长术1例，胃管代食管术9例。分析的术后并发症包括：早期死亡，2/28例由于伴随畸形（中心A）和0/24（中心B）;吻合口漏，4/26（中心A）保守治疗-所有患者都进行了对比研究-0/24（中心B），1例胸腔积液，但未进行常规造影检查;复发性狭窄，13/26 A中心5/26例，B中心7/15例，需行胃底折叠术2/15例。中心A和中心B的食管连续性年龄中位数分别为31天和110天。初始程序和食管吻合之间的中位时间为11天，在中心A和92天，在中心B。ConclusionThoracoscopic内部牵引技术减少时间，以实现食管的连续性和需要食管替代，同时保持类似的早期并发症发生率。
ObjectiveManagement of long gap esophageal atresia (LGOA) is controversial. This study aims at comparing the management of LGOA between two high-volume centers.MethodsWe included patients with LGOA (type A and B) between 2008 and 2022. Demographics, surgical methods, and outcomes were collected and compared.ResultsThe study population involved 28 patients in center A and 24 patients in center B. A surgical approach was thoracoscopic in center A, only for one patient was open for final procedure. In center B, 3 patients were treated only thoracoscopically, 2 converted to open, and 19 as open surgery. In center A primary esophageal anastomosis concerned 1 case, two-staged esophageal lengthening using external traction 1 patient, and 26 were treated with the multistaged internal traction technique. In 24 patients a full anastomosis was achieved: in 23 patients only the internal traction technique was used, while 1 patient required open Collis–Nissen procedure as final management. In center B primary anastomosis was performed in 7 patients, delayed esophageal anastomosis in 8 patients, esophageal lengthening using external traction in 1 case, and 9 infants required esophageal replacement with gastric tube. Analyzed postoperative complications included: early mortality, 2/28 due to accompanied malformations (center A) and 0/24 (center B); anastomotic leakage, 4/26 (center A) treated conservatively—all patients had a contrast study—and 0/24 (center B), 1 case of pleural effusion, but no routine contrast study; recurrent strictures, 13/26 (center A) and 7/15 (center B); and need for fundoplication, 5/26 (center A) and 2/15 (center B). Age at esophageal continuity was as a median of 31 days in center A and 110 days in center B. Median time between initial procedure and esophageal anastomosis was 11 days in center A and 92 days in center B.ConclusionThoracoscopic internal traction technique reduces time to achieve esophageal continuity and the need for esophageal substitution while maintaining a similar early complication rate.