Wang Jun.An in-depth understanding of perioperative complications of congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,,20():1101-1107.[doi:10.12260/lcxewkzz.2021.12.001]
An in-depth understanding of perioperative complications of congenital esophageal atresia
- Keywords:
- Esophageal Atresia/CN; Intraoperative Complications/TH; Postoperative Complications/SU; Postoperative Complications/TH
- CLC:
- R571;R726.1
- Abstract:
- With the continuous promotion of clinical diagnosis and treatment of congenital esophageal atresia (CEA) and the improvement of the application capacity of various technologies, the outcome of CEA in China has been significantly improved.However, the incidence of various perioperative complications and sequelae are gradually increasing as well, which bring serious long-term impact on patients’ life quality.In this review, perioperative CEA complications that are easily ignored are discussed, including peroperative complicaitons like inhalation pneumonia, pulmonary infection and gastric perforation;intraoperative complicaitons like thoracoscopy-related hypercapnia and acidosis and anesthesia-related complications;postoperative complications like anastomotic leak caused by esophageal rupture during dilatation, missed/recurrent tracheoesophageal fistula, vocal cord dysfunction and tracheomalacisa.We summarized published literature and clinical experience from domestic institutions related to CEA management, and focused on the causes and consequences of complications and compared the curative effect among various treatments.We proposed feasible preventive and diagnostic recommendations for targeted treatment strategies, especially for the recognition and management of some difficult complications as well as airway related complications, swallowing function, long-term quality of life that may be ignored before.The aim is to improve the comprehensive treatment of esophageal atresia and to improve the life quality of patients from infancy to adulthood.
References:
1 Jové Blanco A, Gutiérrez Vélez A, Solís-García G, et al.Comorbidities and course of lung function in patients with congenital esophageal atresia[J].Arch Argent Pediatr, 2020, 118(1):25-30.DOI:10.5546/aap.2020.eng.25.
2 Traini I, Menzies J, Hughes J, et al.Oesophageal atresia:The growth gap[J].World J Gastroenterol, 2020, 26(12):1262-1272.DOI:10.3748/wjg.v26.i12.1262.
3 Kimble RM, Harding JE, Kolbe A.The vulnerable stomach in babies born with pure oesophageal atresia[J].Pediatr Surg Int, 1999, 15(7):467-469 DOI:10.1007/s003830050640.
4 Acer T, Karnak I, Yal?in S, et al.Why gastric perforation occurs in patients with isolated esophageal atresia:more vulnerable stomach?[J].Turk J Pediatr, 2012, 54(3):312-316.
5 Knottenbelt G, Costi D, Stephens P, et al.An audit of anesthetic management and complications of tracheoesophageal fistula and esophageal atresia repair[J].Paediatr Anaesth, 2012, 22(3):268-274.DOI:10.1111/j.1460-9592.2011.03738.x.
6 Tytgat SH, van Herwaarden MY, Stolwijk LJ, et al.Neonatal brain oxygenation during thoracoscopic correction of esophageal atresia[J].Surg Endosc, 2016, 30(7):2811-2817.DOI:10.1007/s00464-015-4559-1.
7 Zani A, Lamas-Pinheiro R, Paraboschi I, et al.Intraoperative acidosis and hypercapnia during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia/tracheoesophageal fistula[J].Paediatr Anaesth, 2017, 27(8):841-848.DOI:10.1111/pan.13178.
8 Rathod KK, Bawa M, Mahajan JK, et al.Management of esophageal atresia with a tracheoesophageal fistula complicated by gastric perforation[J].Surg Today, 2011, 41(10):1391-1394.DOI:10.1007/s00595-010-4460-4.
9 Lobe TE, Rothenberg SS, Waldshmidt J, et al.Thoracoscopic repair of esophageal atresia in an infant:a surgical first[J].Pediatr Endosurg Innov Tech, 1999, 3:141-148.
10 Bishay M, Giacomello L, Retrosi G, et al.Decreased cerebral oxygen saturation during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia in infants[J].J Pediatr Surg, 2011, 46(1):47-51.DOI:10.1016/j.jpedsurg.2010.09.062.
11 Bishay M, Giacomello L, Retrosi G, et al.Hypercapnia and acidosis during open and thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia:results of a pilot randomized controlled trial[J].Ann Surg, 2013, 258(6):895-900.DOI:10.1097/SLA.0b013e31828fab55.
12 Neunhoeffer F, Warmann SW, Hofbeck M, et al.Elevated intrathoracic CO2 pressure during thoracoscopic surgery decreases regional cerebral oxygen saturation in neonates and infants-a pilot study[J].Paediatr Anaesth, 2017, 27(7):752-759.DOI:10.1111/pan.13161.
13 Inoue M, Uchida K, Otake K, et al.Thoracoscopic repair of congenital diaphragmatic hernia with countermeasures against reported complications for safe outcomes comparable to laparotomy[J].Surg Endosc, 2016, 30(3):1014-1019.DOI:10.1007/s00464-015-4287-6.
14 Knottenbelt G, Costi D, Stephens P, et al.An audit of anesthetic management and complications of tracheoesophageal fistula and esophageal atresia repair[J].Paediatr Anaesth, 2012, 22(3):268-274.DOI:10.1111/j.1460-9592.2011.03738.x.
15 Sun S, Pan W, Wu W, et al.Elongation of esophageal segments by bougienage stretching technique for long gap esophageal atresia ot achieve delayed primary anastomosis by troracotomy or trhracoscopic repair:a first experience from China[J].J Pediatr Surg, 2018, 53(8):1584-1587.DOI:10.1016/j.jpedsurg.2017.12.009.
16 Lal DR, Gadepalli SK, Downard CD, et al.Midwest pediatric surgery consortium.challenging surgical dogma in the management of proximal esophageal atresia with distal tracheoesophageal fistula:outcomesfrom the midwest pediatric surgery consortium[J].J Pediatr Surg, 2018, 53(7):1267-1272.DOI:10.1016/j.jpedsurg.2017.05.024.
17 Mathur S, Vasudevan SA, Patterson DM, et al.Novel use of glycopyrrolate (Robinul) in the treatment of anastomotic leak after repair of esophageal atresia and tracheoesophageal fistula[J].J Pediatr Surg, 2011, 46(3):e29-e32.DOI:10.1016/j.jpedsurg.2010.11.040.
18 Mencio MA, Ontiveros E, Burdick JS, et al.Use of a novel technique to manage gastrointestinal leaks with endoluminal negative pressure:a single institution experience[J].Surg Endosc, 2018, 32(7):3349-3356.DOI:10.1007/s00464-018-6055-x.
19 Koivusalo AI, Pakarinen MP, Lindahl HG, et al.Revisional surgery for recurrent tracheoesophageal fstula and anastomotic complications after repair of esophageal atresia in 258 infants[J].J Pediatr Surg, 2015, 50(2):250-254.DOI:10.1016/j.jpedsurg.2014.11.004.
20 Friedmacher F, Kroneis B, Huber-Zeyringer A, et al.Postoperative complications and functional outcome after esophageal atresia repair:results from longitudinal single-center follow-up[J].J Gastrointest Surg, 2017, 21(6):927-935.DOI:10.1007/s11605-017-3423-0.
21 Zhang M, Lin Y, Xie W, et al.The multidisciplinary management of recurrent tracheoesophageal fstula after esophageal atresia:Experience with 135 cases from a tertiary center[J].J Pediatr Surg, 2021, 56(11):1918-1925.DOI:10.1016/j.jpedsurg.2020.12.019.
22 Boybeyi Türer ?, Tanyel FC, Soyer T.Acquired tracheoesophageal fistula after esophageal atresia repair[J].Balkan Med J, 2020, 37(1):47-49.DOI:10.4274/balkanmedj.galenos.2019.2019.8.60.
23 Smithers CJ, Hamilton TE, Manfredi MA, et al.Categorization and repair of recurrent and acquired tracheoesophageal fistulae occurring after esophageal atresia repair[J].J Pediatr Surg, 2017, 52(3):424-430.DOI:10.1016/j.jpedsurg.2016.08.012.
24 Aworanti O, Awadalla S.Management of recurrent tracheoesophageal fistulas:a systematic review[J].Eur J Pediatr Surg, 2014, 24(5):365-375.DOI:10.1055/s-0034-1370780.
25 Wang J, Zhang M, Pan W, et al.Management of recurrent tracheoesophageal fistula after esophageal atresia and follow-up[J].Dis Esophagus, 2017, 30(9):1-8.DOI:10.1093/dote/dox081.
26 Morini F, Iacobelli BD, Crocoli A, et al.Symptomatic vocal cord paresis/paralysis in infants operated on for esophageal atresia and/or tracheo-esophageal fistula[J].J Pediatr, 2011, 158(6):973-976.DOI:10.1016/j.jpeds.2010.12.006.
27 Oestreicher-Kedem Y, DeRowe A, Nagar H, et al.Vocal fold paralysis in infants with tracheoesophageal fistula[J].Ann Otol Rhinol Laryngol, 2008, 117(12):896-901.DOI:10.1177/000348940811701206.
28 Qi BQ, Merei J, Farmer P, et al.The vagus and recurrent laryngeal nerves in the rodent experimental model of esophageal atresia[J].J Pediatr Surg, 1997, 32(11):1580-1586.DOI:10.1016/s0022-3468(97)90457-7.
29 Lal DR, Gadepalli SK, Downard CD, et al.Midwest Pediatric Surgery Consortium.Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula[J].J Pediatr Surg, 2017, 52(8):1245-1251.DOI:10.1016/j.jpedsurg.2016.11.046.
30 Woo S, Lau S, Yoo E, et al.Thoracoscopic versus open repair of tracheoesophageal fistulas and rates of vocal cord paresis[J].J Pediatr Surg, 2015, 50(12):2016-2018.DOI:10.1016/j.jpedsurg.2015.08.021.
31 Givens DJ, Buchmann LO, Park AH.A novel surgical management of hypopharyngeal branchial anomalies[J].Int J Pediatr Otorhinolaryngol, 2015, 79(4):579-583.DOI:10.1016/j.ijporl.2015.01.032.
32 King EF, Blumin JH.Vocal cord paralysis in children[J].Curr Opin Otolaryngol Head Neck Surg, 2009, 17(6):483-487.DOI:10.1097/MOO.0b013e328331b77e.
33 Kovesi T, Rubin S.Long-term complications of congenital esophageal atresia and/or tracheoesophageal fistula[J].Chest, 2004, 126(3):915-925.DOI:10.1378/chest.126.3.915.
34 Thakkar H, Upadhyaya M, Yardley IE.Bronchoscopy as a screening tool for symptomatic tracheomalacia in oesophageal atresia[J].J Pediatr Surg, 2018, 53(2):227-229.DOI:10.1016/j.jpedsurg.2017.11.003.
35 Gottrand F, Sfeir R, Thumerelle C, et al.Esophageal atresia[J].Arch Pediatr, 2012, 19(9):932.DOI:10.1016/j.arcped.2012.06.012.
36 国家卫生健康委员会人才交流服务中心儿科呼吸内镜诊疗技术专家组, 中国医师协会儿科医师分会内镜专业委员会, 中国医师协会内镜医师分会儿科呼吸内镜专业委员会, 等.中国儿科可弯曲支气管镜术指南(2018年版)[J].中华实用儿科临床杂志, 2018, 33(13):983-989.DOI:10.3760/cma.j.issn.2095-428X.2018.13.006. Expert Group of Pediatric Respiratory Endoscopy Diagnosis and Treatment Technology, Personnel Exchange Service Center of National Health Commission, Professional Committee of Endoscopy, respiratory Endoscopy Committee of Pediatric Department, Endoscopic Division, Chinese Medical Association, et al.Guideline of pediatric flexible bronchoscopy in China(2018 version)[J].Chinese Journal of Applied Clinical Pediatrics, 2018, 33(13):983-989.DOI:10.3760/cma.j.issn.2095-428X.2018.13.006.
37 Fayoux P, Morisse M, Sfeir R, et al.Laryngotracheal anomalies associated with esophageal atresia:importance of early diagnosis[J].Eur Arch Otorhinolaryngol, 2018, 275(2):477-481.DOI:10.1007/s00405-017-4856-5.
38 Page BA, Klein EF Jr.Tracheal stent as an aid in weaning from mechanical ventilation in tracheomalacia[J].Anesthesiology, 1977, 47(3):300-301.DOI:10.1097/00000542-197709000-00013.
39 Zhang Z, Ma J, Liu S, et al.Fully-covered metallic stenting in an infant with tracheoesophageal fistula due to button battery ingestion[J].Int J Pediatr Otorhi, 2017, 95:80-83.DOI:10.1016/j.ijporl.2017.01.035.
40 van der Zee DC, Straver M.Thoracoscopic aortopexy for tracheomalacia[J].World J Surg, 2015, 39(1):158-164.DOI:10.1007/s00268-014-2798-2.
41 Filler RM, Messineo A, Vinograd I.Severe tracheomalacia associated with esophageal atresia:results of surgical treatment[J].J Pediatr Surg, 1992, 27(8):1136-1140.DOI:10.1016/0022-3468(92)90575-r.
Memo
收稿日期:2021-10-18。
基金项目:1.上海市科委研究项目（编号：19441905500）；2.上海申康医院发展中心第二轮临床三年行动计划重大临床研究项目（编号：SHDC2020CR2063B）
通讯作者:王俊,Email:jwangjl@126.com