目的:本研究旨在评估长间隙食管闭锁(LGEA)伴或不伴气管食管瘘(TEF)的不同手术方法。
方法:对LGEA+/-TEF患儿胃移位术与食管延长术联合延迟一期吻合术进行了系统的文献综述。主要结果是完全口服喂养的时间。次要结果是完全肠道喂养的时间,需要进一步的手术,增长,死亡率,和术后不良事件。
结果:没有发现比较研究。然而,这些文献被重新询问用于非比较研究。鉴定和筛选了4138篇文章,18人符合纳入标准。都是系列案例。43名婴儿接受了胃移位术,106例食管延长合并延迟原发性吻合术。一项关于胃移位的研究报告了完全口服喂养的时间,每组的一项研究报告了生长情况。在每组的一项研究中报告了完全肠溶饲料的时间。30%的婴儿在胃转位后接受了进一步的手术,包括裂孔疝修补术(5/43,12%)和食管扩张术(7/43,16%)。食道延长后,62/106(58%)进行了抗反流手术,58/106(55%)食管扩张和11/106(10%)食管狭窄切除。吻合口并发症发生在13/43(30%),胃肠道16/43(37%),17/43(40%)呼吸,胃移位组有2/43(5%)的神经损伤。在食管延长组中,吻合口并发症发生在68/106(64%),62/106(58%),6/106(6%)呼吸,也没有神经损伤.由于与外科手术没有直接关系的原因,每组都有1人死亡。
结论:本系统综述强调了与外科手术相关的发病率和报告结果的多样性。
OBJECTIVE: This study aims to evaluate different surgical approaches to long-gap esophageal atresia (LGEA) with or without tracheoesophageal fistula (TEF) is unclear.
METHODS: A systematic literature review was done comparing gastric transposition versus esophageal lengthening with delayed primary anastomosis in infants with LGEA+/-TEF. The primary outcome was time to full oral feeds. Secondary outcomes were time to full enteric feeds, need for further surgery, growth, mortality, and postoperative adverse events.
RESULTS: No comparative studies were found. However, the literature was re-interrogated for non-comparative studies. Four hundred thirty-eight articles were identified and screened, and 18 met the inclusion criteria. All were case series. Forty-three infants underwent gastric transposition, and 106 had esophageal lengthening with delayed primary anastomosis. One study on gastric transposition reported time to full oral feeds, and one study in each group reported growth. Time to full enteric feeds was reported in one study in each group. 30% of infants had further surgery following gastric transposition, including hiatus hernia repair (5/43, 12%) and esophageal dilation (7/43, 16%). Following esophageal lengthening, 62/106 (58%) had anti-reflux surgery, 58/106 (55%) esophageal dilatation and 11/106 (10%) esophageal stricture resection. Anastomotic complications occurred in 13/43 (30%), gastrointestinal in 16/43 (37%), respiratory in 17/43 (40%), and nerve injury in 2/43 (5%) of the gastric transposition group. In the esophageal lengthening group, anastomotic complications occurred in 68/106 (64%), gastrointestinal in 62/106 (58%), respiratory in 6/106 (6%), and none sustained nerve injury. Each group had one death due to a cause not directly related to the surgical procedure.
CONCLUSIONS: This systematic review highlights the morbidity associated with both surgical procedures and the variety in reporting outcomes.