PDF(Pubmed)
Abstract：
Background and Aims: Children with esophageal atresia (EA) who undergo surgical repair are at risk for anastomotic stricture, which may need multiple dilations or surgical resection if the stricture proves refractory to endoscopic therapy. To date, no studies have assessed the predictive value of anastomotic diameter on long-term treatment outcomes. Our aim was to evaluate the relationship between anastomotic diameter in the early postoperative period and need for frequent dilations and stricture resection within 1 year of surgical repair. Methods: A retrospective chart review was performed of patients who had EA repair or stricture resection (SR). Medical records were reviewed to evaluate the diameter of the anastomosis at the first endoscopy after surgery, number and timing of dilations needed to treat the anastomotic stricture, and need for stricture resection. A generalized estimating equations (GEE) modeling with a logit link and binomial family was done to analyze the relationship between initial endoscopic anastomosis diameter and the outcome of needing a stricture resection. Median regression was implemented to estimate the association between number of dilations needed based on initial diameter. Results: A total of 121 patients (56 females) with a history of EA (64% long-gap EA) were identified who either underwent Foker repair at 46% or stricture resection with end-to-end esophageal anastomosis at 54%. The first endoscopy occurred a median of 22 days after surgery. Among all cases, a narrower anastomoses were more likely to need stricture resection with an OR of 12.9 (95% CI, 3.52, 47; p < 0.001) in patients with an initial diameter of <3 mm. The number of dilations that patients underwent also decreased as anastomotic diameter increased. This observation showed a significant difference when comparing all diameter categories when looking at all surgeries taken as a whole (p < 0.008). Conclusion: Initial anastomotic diameter as assessed via endoscopy performed after high-risk EA repair predicts which patients will require more esophageal dilations as well as the likelihood for stricture resection. This data may serve to stratify patients into different endoscopic treatment plans.
摘要：
背景和目的：接受手术修复的食管闭锁（EA）儿童有吻合口狭窄的风险，如果狭窄被证明对内窥镜治疗无效，则可能需要多次扩张或手术切除。迄今为止,尚无研究评估吻合口直径对长期治疗结局的预测价值.我们的目的是评估术后早期吻合口直径与手术修复后1年内需要频繁扩张和狭窄切除之间的关系。方法：对接受EA修复或狭窄切除术（SR）的患者进行回顾性分析。在手术后的第一次内窥镜检查时，对医疗记录进行了审查，以评估吻合口的直径。治疗吻合口狭窄所需的扩张次数和时机，需要进行狭窄切除.进行了具有logit链接和二项式家族的广义估计方程（GEE）建模，以分析初始内窥镜吻合直径与需要狭窄切除的结果之间的关系。实施中值回归以估计基于初始直径所需的扩张次数之间的关联。结果：共有121例（56例女性）有EA病史（64％的长间隙EA），其中46％接受了Foker修复术或54％的端到端食管吻合术。第一次内窥镜检查的中位数为手术后22天。在所有案件中,在初始直径<3mm的患者中,狭窄的吻合口更可能需要狭窄切除,OR为12.9(95%CI,3.52,47;p<0.001).随着吻合口直径的增加，患者接受的扩张次数也减少。当观察作为整体的所有手术时,当比较所有直径类别时,该观察显示出显著差异(p<0.008)。结论：高风险EA修复后通过内窥镜评估的初始吻合口直径可预测哪些患者需要更多的食管扩张以及狭窄切除的可能性。该数据可以用于将患者分层为不同的内窥镜治疗计划。
