Abstract：
BACKGROUND: Esophageal atresia (EA) is often associated with tracheomalacia (TM). The severity of TM symptoms varies widely, with serious cases requiring prolonged respiratory support and surgical treatment. Although we performed thoracoscopic posterior tracheopexy (TPT) during primary EA repair to prevent or reduce the symptoms of TM, few studies have investigated the safety and effectiveness of TPT during primary EA repair. Therefore, this study aimed to evaluate the safety and efficacy of TPT in neonates.
METHODS: We retrospectively reviewed the records of all patients diagnosed with TM who underwent primary thoracoscopic EA repair between 2013 and 2020 at the Nagoya University Hospital. Patients were divided into two groups: TPT (TPT group) and without TPT (control group). TPT has been performed in all patients with EA complicated by TM since 2020. We compared patient backgrounds, surgical outcomes, postoperative complications, and treatment efficacy.
RESULTS: Of the 22 patients reviewed, eight were in the TPT group and 14 were in the control group. There were no statistically significant differences in the surgical outcomes between the groups (operation time: p = 0.31; blood loss: p = 0.83; time to extubation: p = 0.30; time to start enteral feeding: p = 0.19; time to start oral feeding: p = 0.43). Conversion to open thoracotomy was not performed in any case. The median operative time required for posterior tracheopexy was 10 (8-15) min. There were no statistically significant differences in postoperative complications between the groups (chylothorax: p = 0.36; leakage: p = 1.00; stricture: p = 0.53). The respiratory dependence rate 30 days postoperative (2 [25%] vs. 11 [79%], p = 0.03) and the ratio of the lateral and anterior-posterior diameter of the trachea (LAR) were significantly lower in the TPT group (1.83 [1.66-2.78] vs. 3.59 [1.80-7.70], p = 0.01).
CONCLUSIONS: TPT during primary EA repair for treatment of TM significantly lowered respiratory dependence rate at 30 days postoperative without increasing the risk of postoperative complications. This study suggested that TPT could improve TM associated with EA.
METHODS: We retrospectively reviewed the records of all patients diagnosed with TM who underwent primary thoracoscopic EA repair between 2013 and 2020 at the Nagoya University Hospital. Patients were divided into two groups: TPT (TPT group) and without TPT (control group). TPT has been performed in all patients with EA complicated by TM since 2020. We compared patient backgrounds, surgical outcomes, postoperative complications, and treatment efficacy.
RESULTS: Of the 22 patients reviewed, eight were in the TPT group and 14 were in the control group. There were no statistically significant differences in the surgical outcomes between the groups (operation time: p = 0.31; blood loss: p = 0.83; time to extubation: p = 0.30; time to start enteral feeding: p = 0.19; time to start oral feeding: p = 0.43). Conversion to open thoracotomy was not performed in any case. The median operative time required for posterior tracheopexy was 10 (8-15) min. There were no statistically significant differences in postoperative complications between the groups (chylothorax: p = 0.36; leakage: p = 1.00; stricture: p = 0.53). The respiratory dependence rate 30 days postoperative (2 [25%] vs. 11 [79%], p = 0.03) and the ratio of the lateral and anterior-posterior diameter of the trachea (LAR) were significantly lower in the TPT group (1.83 [1.66-2.78] vs. 3.59 [1.80-7.70], p = 0.01).
CONCLUSIONS: TPT during primary EA repair for treatment of TM significantly lowered respiratory dependence rate at 30 days postoperative without increasing the risk of postoperative complications. This study suggested that TPT could improve TM associated with EA.
摘要：
背景：食管闭锁（EA）通常与气管软化（TM）有关。TM症状的严重程度差异很大，严重病例需要长期呼吸支持和手术治疗。尽管我们在初次EA修复期间进行了胸腔镜后路气管固定术（TPT）以预防或减轻TM的症状，很少有研究调查TPT在初次EA修复期间的安全性和有效性。因此,本研究旨在评估新生儿TPT的安全性和有效性。
方法：我们回顾性回顾了2013年至2020年在名古屋大学医院接受原发性胸腔镜EA修复的所有诊断为TM的患者的记录。将患者分为两组：TPT组（TPT组）和无TPT组（对照组）。自2020年以来，所有EA并发TM患者都进行了TPT。我们比较了病人的背景,手术结果,术后并发症,和治疗效果。
结果：在22例患者中，TPT组8例，对照组14例。组间手术结果差异无统计学意义(手术时间:p=0.31;失血量:p=0.83;拔管时间:p=0.30;开始肠内喂养时间:p=0.19;开始口服喂养时间:p=0.43)。在任何情况下都没有进行开胸手术的转换。后气管固定术所需的中位手术时间为10（8-15）分钟。两组术后并发症无统计学差异（乳糜胸：p=0.36；渗漏：p=1.00；狭窄：p=0.53）。术后30天呼吸依赖率(2[25%]vs.11[79%]，p=0.03），TPT组气管外侧和前后直径（LAR）的比值显着降低（1.83[1.66-2.78]vs.3.59[1.80-7.70],p=0.01)。
结论：TPT用于治疗TM，在术后30天显著降低呼吸依赖率，而不增加术后并发症的风险。这项研究表明，TPT可以改善与EA相关的TM。
方法：我们回顾性回顾了2013年至2020年在名古屋大学医院接受原发性胸腔镜EA修复的所有诊断为TM的患者的记录。将患者分为两组：TPT组（TPT组）和无TPT组（对照组）。自2020年以来，所有EA并发TM患者都进行了TPT。我们比较了病人的背景,手术结果,术后并发症,和治疗效果。
结果：在22例患者中，TPT组8例，对照组14例。组间手术结果差异无统计学意义(手术时间:p=0.31;失血量:p=0.83;拔管时间:p=0.30;开始肠内喂养时间:p=0.19;开始口服喂养时间:p=0.43)。在任何情况下都没有进行开胸手术的转换。后气管固定术所需的中位手术时间为10（8-15）分钟。两组术后并发症无统计学差异（乳糜胸：p=0.36；渗漏：p=1.00；狭窄：p=0.53）。术后30天呼吸依赖率(2[25%]vs.11[79%]，p=0.03），TPT组气管外侧和前后直径（LAR）的比值显着降低（1.83[1.66-2.78]vs.3.59[1.80-7.70],p=0.01)。
结论：TPT用于治疗TM，在术后30天显著降低呼吸依赖率，而不增加术后并发症的风险。这项研究表明，TPT可以改善与EA相关的TM。
