Wu Wenjie,Lin Yangwen,Gong Yiming,et al.Clinical experience of elongating esophageal segments through Bougienage stretching technique for pure esophageal atresia[J].Journal of Clinical Pediatric Surgery,,22():335-339.[doi:10.3760/cma.j.cn101785-202303014-007]
Clinical experience of elongating esophageal segments through Bougienage stretching technique for pure esophageal atresia
- Keywords:
- Esophageal Atresia; Surgical Procedures; Operative; Traction; Treatment Outcome
- Abstract:
- Objective To summarize clinical experience of elongating esophageal segments through Bougienage stretching technique for pure esophageal atresia (EA) to achieve delayed primary anastomosis.Methods From January 2015 to December 2018,32 children of pure EA underwent Bougienage stretching technique before esophageal anastomosis.Results All of them survived postoperatively.Initial assessment revealed a proximal-distal length of (5.5±1.5)cm.After elongating for (68.2±41.3) days,the length shortened to (-0.5±0.9)cm.Reconstruction was performed by thoracoscopy (n=27) and thoracotomy (n=5).The postoperative complications included anastomotic leakage (n=9),stenosis (n=30),hiatal hernia (n=9),malnutrition (n=8) and developmental delay (n=6).Conclusion Bougienage stretching technique for pure EA is feasible with satisfactory clinical outcomes with autogenous esophagus for primary anastomosis.It is ideal for restoring esophageal function and enhancing quality-of-life of EA children.
References:
[1] van der Zee DC,Bagolan P,Faure C,et al.Position paper of INoEA working group on long-gap esophageal atresia:for better care[J].Front Pediatr,2017,5:63.DOI:10.3389/fped.2017.00063.
[2] Stadil T,Koivusalo A,Svensson JF,et al.Surgical treatment and major complications within the first year of life in newborns with long-gap esophageal atresia gross type A and B-a systematic review[J].J Pediatr Surg,2019,54(11):2242-2249.DOI:10.1016/j.jpedsurg.2019.06.017.
[3] Dingemann C,Eaton S,Aksnes G,et al.ERNICA consensus conference on the management of patients with long-gap esophageal atresia:perioperative,surgical,and long-term management[J].Eur J Pediatr Surg,2021,31(3):214-225.DOI:10.1055/s-0040-1713932.
[4] 孙苏娜,潘伟华,邬文杰,等.食管内牵引延长治疗长段缺失型食管闭锁[J].中华小儿外科杂志,2018,39(4):246-249.DOI:10.3760/cma.j.issn.0253-3006.2018.04.002. Sun SN,Pan WH,Wu WJ,et al.Efficacy of delayed internal traction for long-gap esophageal atresia[J].Chin J Pediatr Surg,2018,39(4):246-249.DOI:10.3760/cma.j.issn.0253-3006.2018.04.002.
[5] Soyer T,Yalcin S,Arslan SS,et al.Pediatric eating assessment Tool-10 as an indicator to predict aspiration in children with esophageal atresia[J].J Pediatr Surg,2017,52(10):1576-1579.DOI:10.1016/j.jpedsurg.2017.02.018.
[6] Crary MA,Mann GD,Groher ME.Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients[J].Arch Phys Med Rehabil,2005,86(8):1516-1520.DOI:10.1016/j.apmr.2004.11.049.
[7] von Allmen D,Wijnen RM.Bridging the gap in the repair of long-gap esophageal atresia:still questions on diagnostics and treatment[J].Eur J Pediatr Surg,2015,25(4):312-317.DOI:10.1055/s-0035-1562926.
[8] Rothenberg SS,Flake AW.Experience with thoracoscopic repair of long gap esophageal atresia in neonates[J].J Laparoendosc Adv Surg Tech A,2015,25(11):932-935.DOI:10.1089/lap.2015.0124.
[9] Varjavandi V,Shi E.Early primary repair of long gap esophageal atresia:the VATER operation[J].J Pediatr Surg,2000,35(12):1830-1832.DOI:10.1053/jpsu.2000.19279.
[10] Spitz L.Esophageal replacement:overcoming the need[J].J Pediatr Surg,2014,49(6):849-852.DOI:10.1016/j.jpedsurg.2014.01.011.
[11] 王俊,潘伟华,谢伟,等.长段缺失型食管闭锁的治疗体会[J].中华小儿外科杂志,2014,35(8):572-576.DOI:10.3760/cma.j.issn.0253-3006.2014.08.004. Wang J,Pan WH,Xie W,et al.Experiences of treating long-gap esophageal atresia[J].Chin J Pediatr Surg,2014,35(8):572-576.DOI:10.3760/cma.j.issn.0253-3006.2014.08.004.
[12] Myers NA.Oesophageal atresia:the epitome of modern surgery[J].Ann R Coll Surg Engl,1974,54(6):277-287.
[13] Lee HQ,Hawley A,Doak J,et al.Long-gap oesophageal atresia:comparison of delayed primary anastomosis and oesophageal replacement with gastric tube[J].J Pediatr Surg,2014,49(12):1762-1766.DOI:10.1016/j.jpedsurg.2014.09.017.
[14] Mochizuki K,Obatake M,Taura Y,et al.A modified Foker’s technique for long gap esophageal atresia[J].Pediatr Surg Int,2012,28(8):851-854.DOI:10.1007/s00383-012-3151-1.
[15] Sroka M,Wachowiak R,Losin M,et al.The Foker technique (FT) and Kimura advancement (KA) for the treatment of children with long-gap esophageal atresia (LGEA):lessons learned at two European centers[J].Eur J Pediatr Surg,2013,23(1):3-7.DOI:10.1055/s-0033-1333891.
[16] Zimmer J,Eaton S,Murchison LE,et al.State of play:eight decades of surgery for esophageal atresia[J].Eur J Pediatr Surg,2019,29(1):39-48.DOI:10.1055/s-0038-1668150.
[17] Beger B,Beger O.A new esophageal elongation technique for long-gap esophageal atresia:in vitro comparison of myotomy techniques[J].Esophagus,2019,16(1):93-97.DOI:10.1007/s10388-018-0636-6.
[18] 邬文杰,潘伟华,严文波,等.食管盲袋翻转成形食管延长术治疗Ⅰ型食管闭锁的临床研究[J].临床小儿外科杂志,2018,17(3):174-178.DOI:10.3969/j.issn.1671-6353.2018.03.004. Wu WJ,Pan WH,Yan WB,et al.Clinical trial of treating pure esophageal atresia with cystic pouch of proximal esophagus[J].J Clin Ped Sur,2018,17(3):174-178.DOI:10.3969/j.issn.1671-6353.2018.03.004.
[19] Nurminen P,Koivusalo A,Hukkinen M,et al.Pneumonia after repair of esophageal atresia-incidence and main risk factors[J].Eur J Pediatr Surg,2019,29(6):504-509.DOI:10.1055/s-0038-1675775.
[20] Donoso F,Hedenstr?m H,Malinovschi A,et al.Pulmonary function in children and adolescents after esophageal atresia repair[J].Pediatr Pulmonol,2020,55(1):206-213.DOI:10.1002/ppul.24517.
[21] Porcaro F,Valfré L,Aufiero LR,et al.Respiratory problems in children with esophageal atresia and tracheoesophageal fistula[J].Ital J Pediatr,2017,43(1):77.DOI:10.1186/s13052-017-0396-2.
[22] Capitanio M,Guaná R,Garofalo S,et al.Quality of life and long-term results in patients operated on for esophageal atresia[J/OL].Minerva Pediatr(Torino),2021.https://pubmed.ncbi.nlm.nih.gov/34859650/.DOI:10.23736/S2724-5276.21.06597-6.
[23] Menon P,Narasimha Rao KL,Samujh R,et al.Reverse gastric tube esophagoplasty with and without lower esophageal stump wrap-comparison of outcome[J].J Indian Assoc Pediatr Surg,2022,27(2):173-179.DOI:10.4103/jiaps.JIAPS_356_20.
[24] Mahoney L,Rosen R.Feeding problems and their underlying mechanisms in the esophageal atresia-tracheoesophageal fistula patient[J].Front Pediatr,2017,5:127.DOI:10.3389/fped.2017.00127.
Memo
收稿日期:2023-3-5。
基金项目:上海申康医院发展中心重大临床研究项目(SHDC2020CR2063B)
通讯作者:王俊,Email:jwangjl@126.com