背景:磁压缩吻合术(MCA)是长间隙食管闭锁(EA)患者的替代技术。它允许保存天然食道。我们旨在系统地总结当前有关EA中MCA的文献。方法:包括使用MCA设备治疗EA新生儿的研究,而食管狭窄的研究被排除。所有的临床研究,包括比较研究,案例系列,和病例报告,有资格列入。使用经过验证的工具进行方法学质量评估。结果:12项研究共42例患者纳入本综述。关于开始MCA的时间(1天至7个月),这些研究之间存在很大差异。手术时间(13-320分钟),和磁铁特性(强度,尺寸,和所用磁铁的形状)。实现吻合的时间为1至12天。几乎所有患者都有吻合口狭窄的报道,需要多次内窥镜扩张(中位数扩张/患者=9.8)。9例(21%)患者需要支架置入治疗难治性狭窄,6例(14%)患者需要手术治疗狭窄。仅在4项研究中报道了长期结果包括食管运动障碍(n=3)和复发性肺部感染(n=3)。结论:根据本综述的结果,接受MCA的长间隙EA的新生儿总是需要多次内窥镜扩张(中位数扩张/患者=9.8)。此外,纳入的研究在MCA程序方面存在很大差异.需要采用标准化程序来实现MCA的未来研究,以确定该脆弱患者群体的其他结果。
Background: Magnetic compression anastomosis (MCA) is an alternative technique for patients with long-gap esophageal atresia (EA). It allows for preservation of the native esophagus. We aimed to systematically summarize the current literature on MCA in EA. Methods: Studies where neonates with EA were treated with MCA devices were included, while studies on esophageal stenosis were excluded. All clinical studies, including comparative studies, case series, and case reports, were eligible for inclusion. Methodological quality assessment was performed using a validated tool. Results: Twelve studies with a total of 42 patients were included in this
review. There was a wide variation among these studies with regard to the time of initiation of MCA (1 day to 7 months), procedure time (13-320 minutes), and magnet characteristics (strength, size, and shape of the magnets used). The time to achieve anastomosis ranged from 1 to 12 days. Stricture at the anastomotic site was reported in almost all the patients, which required multiple endoscopic dilatations (median no. of dilatations/patient = 9.8). Stent placement for refractory stricture was required in 9 (21%) patients, and surgery for stricture was required in 6 (14%) patients. Long-term outcomes included esophageal dysmotility (n = 3) and recurrent pulmonary infections (n = 3) were reported in only four studies. Conclusion: As per the findings of this
review, neonates with long-gap EA undergoing MCA would invariably require multiple sittings of endoscopic dilatations (median no. of dilatations/patient = 9.8). Also, there is a wide variation among the included studies in terms of the procedure of MCA. Future studies with a standardized procedure for achieving MCA are needed to determine additional outcomes in this fragile patient population.