Lin Yangwen,Jiang Yi,Wang Jun.Current status and future development of esophageal function after a reconstruction of esophageal atresia[J].Journal of Clinical Pediatric Surgery,2021,20(04):388-392.[doi:10.12260/lcxewkzz.2021.04.016]
食管闭锁重建术后食管功能评估的现状与发展
- Title:
- Current status and future development of esophageal function after a reconstruction of esophageal atresia
- 分类号:
- R726;R571
- 摘要:
- 食管功能异常是食管闭锁(esophageal atresia,EA)患者食管重建术后常见的问题。术后食管功能的恢复或改善对患者生活质量至关重要。随着近年国内EA治愈率的提高,人们开始关注患者术后并发症情况,尤其是术后食管功能的恢复问题。食管功能异常的影响因素众多,不仅与术前既有食管状态有关,同时与手术创伤、术后并发症及形态亦有很大关系。但目前术后食管功能评价体系仍不健全,没有形成有效合理的治疗策略。本文通过总结国内外EA术后食管功能异常的病理生理基础、临床表现、评估手段及治疗经验等,进一步明确食管功能异常相关因素,为探索有效完整且公认的评价体系及治疗策略提供参考依据。
- Abstract:
- Esophageal dysfunction is a common problem after esophageal reconstruction in children with esophageal atresia.Recovery or improvement of postoperative esophageal function is critical for quality-of-life.With the improved cure rate of esophageal atresia in recent years, pediatric surgeons have begun to focus upon the complications and recovery of esophageal function.Many influencing factors of esophageal dysfunction are not only related with preoperative esophageal status, but also surgical trauma, postoperative complications and morphologies.Postoperative evaluation system of esophageal function has remained imperfect and no effective and rational treatment strategy is available.This review intends to summarize the pathophysiological fundamentals, clinical manifestations, assessment methods and treatment experiences of esophageal dysfunction.And the authors try to clarify the factors related with esophageal dysfunction and provide rationales for exploring effective and complete evaluation systems and treatment strategies.
参考文献/References:
1 Spitz L.Oesophageal atresia[J].Orphanet J Rare Dis,2007,2(1):24.DOI:10.1016/j.amjsurg.2014.09.019.
2 Serel Arslan S,Demir N,Karaduman AA,et al.Chewing function in children with repaired esophageal atresia-tracheoesophageal fistula[J].Eur J Pediatr Surg,2018,28(6):534-538.DOI:10.1055/s-0037-1608930.
3 Serel Arslan S,Soyer T,Demir N,et al.Effect of swallowing rehabilitation protocol on swallowing function in patients with and/or tracheoesophageal fistula[J].Eur J Pediatr Surg,2017,27(6):526-532.DOI:10.1055/s-0037-1599231.
4 Connor MJ,Springford LR,Kapetanakis VV,et al.Esophageal atresia and transitional care-step 1:a systematic review and meta-analysis of the literature to define the prevalence of chronic long-term problems[J].Am J Surg,2015,209(4):747-759.DOI:10.1016/j.amjsurg.2014.09.019.
5 Tomaselli V,Volpi ML,Dellagnola CA,et al.Long-term evaluation of esophageal function in patients treated at birth for esophageal atresia[J].Pediatr Surg Int,2003,19:40-43.DOI:10.1007/s00383-002-0887-z.
6 Pedersen RN,Markow S,Kruseandersen S,et al.Esophageal atresia:gastroesophageal functional follow-up in 5-15 year old children[J].J Pediatr Surg,2013,48(12):2487-2495.DOI:10.1016/j.jpedsurg.2013.07.019.
7 Romeo G.Disorders of the esophageal motor activity in atresia of the esophagus[J].J Pediatr Surg,1987,22(2):120-124.DOI:10.1016/S0022-3468(87) 80425-6.
8 Qi BQ,Merei J,Farmer P,et al.The vagus and recurrent laryngeal nerves in the rodent experimental model of esophageal atresia[J].Journal of Pediatric Surgery,1997,32(11):1580-1586.DOI:10.1016/s0022-3468(97) 90457-7.
9 Qi BQ,Uemura S,Farmer P,et al.Intrinsic innervation of the oesophagus in fetal rats with oesophageal atresia[J].Pediatr Surg Int,1999,15(1):2-7.DOI:10.1007/s003830050499.
10 Pederiva F,Burgos E,Francica I,et al.Intrinsic esophageal innervation in esophageal atresia without fistula[J].Pediatr Surg Int,2008,24(1):95-100.DOI:10.1007/s00383-007-2032-5.
11 Van Wijk MP,Knuppe FM,Omari T,et al.Evaluation of gastroesophageal function and mechanisms underlying gastroesophageal reflux in infants and adults born with esophageal atresia[J].J Pediatr Surg,2013,48(12):2496-2505.DOI:10.1016/j.jpedsurg.2013.07.024.
12 Kawahara H,Kubota A,Hasegawa T,et al.Lack of distal esophageal contractions is a key determinant of gastroesophageal reflux disease after repair of esophageal atresia[J].J Pediatr Surg,2007,42(12):2017-2021.DOI:10.1016/j.jpedsurg.2007.08.023.
13 Li K,Zheng S,Xiao X,et al.The structural characteristics and expression of neuropeptides in the esophagus of patients with congenital esophageal atresia and tracheoesophageal fistula[J].J Pediatr Surg,2007,42(8):1433-1438.DOI:10.1016/j.jpedsurg.2007.03.050.
14 Midrio P,Alaggio R,Strojna A,et al.Reduction of interstitial cells of Cajal in esophageal atresia[J].J Pediatr Gastroenterol Nutr,2010,51(5):610-617.DOI:10.1097/MPG.0b013e3181dd9d40.
15 Shono T,Suita S,Arima T,et al.Motility function of the esophagus before primary anastomosis in esophageal atresia[J].J Pediatr Surg,1993,28(5):673-676.DOI:10.1016/0022-3468(93) 90029-k.
16 Davies MRQ.Anatomy of the extrinsic motor nerve supply to mobilized segments of the oesophagus disrupted by dissection during repair of oesophageal atresia with distal fistula[J].BJS,1996,83(9):1268-1270.DOI:10.1046/j.1365-2168.1996.02337.x.
17 Friedmacher F,Kroneis B,Huberzeyringer 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.
18 Krishnan U,Lijuan C,Andrew GJ,et al.Analysis of eosinophilic esophagitis in children with repaired congenital esophageal atresia[J].J Allergy Clin Immunol,2019,143(4):1455-1464.e2.DOI:10.1016/j.jaci.2018.08.040.
19 Ghandour KE,Spitz L,Brereton RJ,et al.Recurrent tracheo-oesophageal fistula:Experience with 24 patients[J].J Paediatr Child Health,1990,26(2):89-91.DOI:10.1111/j.1440-1754.1990.tb02393.x.
20 Said M,Mekki M,Golli M,et al.Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia[J].Br J Radiol,2003,76(901):26-31.DOI:10.1259/bjr/64412147.
21 Macchini F,Parente G,Morandi A,et al.Classification of esophageal strictures following esophageal atresia repair[J].Eur J Pediatr Surg,2017,28(3):243-249.DOI:10.1055/s-0037-1598656.
22 Patel A,Gyawali CP.How to Optimally Apply Impedance in the Evaluation of Esophageal Dysmotility[J].Curr Gastroenterol Rep,2016,18(11):60.DOI:10.1007/s11894-016-0534-9.
23 Kahrilas PJ,Bredenoord AJ,Fox M,et al.The Chicago Classification of esophageal motility disorders,v3.0[J].Neurogastroenterol Motil,2015,27(2):160-174.DOI:10.1111/nmo.12477.
24 Van Wijk MP,Benninga MA,Omari T.Role of the multichannel intraluminal impedance technique in infants and children[J].J Pediatr Gastroenterol Nutr,2009,48(1):2-12.DOI:10.1097/MPG.0b013e31818f0902.
25 Gottrand M,Michaud L,Sfeir R,et al.Motility,digestive and nutritional problems in esophageal atresia[J].Paediatr Respir Rev,2016,19:28-33.DOI:10.1016/j.prrv.2015.11.005.
26 Tovar JA,Fragoso AC.Gastroesophageal reflux after repair of esophageal atresia[J].Eur J Pediatr Surg,2013,23(3):175-181.DOI:10.1055/s-0033-1347911.
27 Somppi E,Tammela O,Ruuska T,et al.Outcome of patients operated on for esophageal atresia:30 Years’ experience[J].J Pediatr Surg,1998,33(9):1341-1346.DOI:10.1016/s0022-3468(98) 90003-3.
28 Miyake H,Chen Y,Hock A,et al.Are prophylactic anti-reflux medications effective after esophageal atresia repair? Systematic review and meta-analysis[J].Pediatr Surg Int,2018,34(5):491-497.DOI:10.1007/s00383-018-4242-4.
29 Di Pace MR,Caruso AM,Farina F,et al.Evaluation of esophageal motility and reflux in children treated for congenital diaphragmatic hernia with the use of combined multichannel intraluminal impedance and pH monitoring[J].J Pediatr Surg,2011,46(10):1881-1886.DOI:10.1016/j.jpedsurg.2011.04.093.
30 Faure C,Righini Grunder F.Dysmotility in esophageal atresia:pathophysiology,characterization,and treatment[J].Front Pediatr,2017,5:130.DOI:10.3389/fped.2017.00130.
31 Yanchar NL,Gordon R,Cooper M,et al.Significance of the clinical course and early upper gastrointestinal studies in predicting complications associated with repair of esophageal atresia[J].J Pediatr Surg,2001,36(5):815-822.DOI:10.1053/jpsu.2001.22969.
32 Pellegrino SA,King SK,Mcleod E,et al.Impact of esophageal atresia on the success of fundoplication for gastroesophageal reflux[J].J Pediatr,2018,198:60-66.DOI:10.1016/j.jpeds.2018.02.059.
33 Koivusalo AI,Rintala RJ,Pakarinen MP.Outcomes of fundoplication in oesophageal atresia associated gastrooesophageal reflux disease[J].J Pediatr Surg,2018,53(2):230-233.DOI:10.1016/j.jpedsurg.2017.11.011.
34 Thyoka M,Timmis A,Mhango T,et al.Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia:a systematic review[J].Pediatr Radiol,2013,43(8):898-901.DOI:10.1007/s00247-013-2693-2.
35 Gebrail R,Absah I.Successful Use of esophageal stent placement to treat a postoperative esophageal stricture in a toddler[J].Acg Case Rep J,2014,2(1):61-63.DOI:10.14309/crj.2014.86.
相似文献/References:
[1]刘仕琪,吕毅.磁吻合技术治疗先天性长段食管闭锁与吻合口狭窄新进展[J].临床小儿外科杂志,2019,18(06):447.[doi:10.3969/j.issn.1671-6353.2019.06.003]
Liu Shiqi,Lv Yi.Recent advances of magnetic compression anastomosis technique for esophageal atresia and anastomotic strictures[J].Journal of Clinical Pediatric Surgery,2019,18(04):447.[doi:10.3969/j.issn.1671-6353.2019.06.003]
[2]谷一超,黄金狮,陈永卫,等.胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄的疗效分析[J].临床小儿外科杂志,2019,18(06):450.[doi:10.3969/j.issn.1671-6353.2019.06.004]
Gu Yichao,Huang Jinshi,Chen Yongwei,et al.Analysis of effectiveness of endoscopy-guided balloon dilatation for anastomotic strictures after repairing esophageal atresia[J].Journal of Clinical Pediatric Surgery,2019,18(04):450.[doi:10.3969/j.issn.1671-6353.2019.06.004]
[3]习林云,吴春,潘征夏,等.Ⅲ型先天性食管闭锁手术后并发症的危险因素分析[J].临床小儿外科杂志,2019,18(06):462.[doi:10.3969/j.issn.1671-6353.2019.06.006]
Xi Linyun,Wu Chun,Pan Zhengxia,et al.Analysis of risk factors of complications in type Ⅲ congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,2019,18(04):462.[doi:10.3969/j.issn.1671-6353.2019.06.006]
[4]梁靓,谭征,黄婷,等.Ⅲ型先天性食管闭锁术后吻合口漏的相关营养评估研究[J].临床小儿外科杂志,2020,19(08):721.[doi:10.3969/j.issn.1671-6353.2020.08.012]
Liang Liang,Tan Zheng,Huang Ting,et al.Nutritional evaluation of postoperative anastomotic leakage in children with type Ⅲ esophageal atresia[J].Journal of Clinical Pediatric Surgery,2020,19(04):721.[doi:10.3969/j.issn.1671-6353.2020.08.012]
[5]陶俊峰,黄金狮,陈快,等.先天性食管闭锁并食管气管瘘手术中瘘管处理方法的对比研究[J].临床小儿外科杂志,2021,20(12):1122.[doi:10.12260/lcxewkzz.2021.12.004]
Tao Junfeng,Huang Jinshi,Chen Kuai,et al.Comparison of management methods of congenital esophageal atresia with esophago tracheal fistula[J].Journal of Clinical Pediatric Surgery,2021,20(04):1122.[doi:10.12260/lcxewkzz.2021.12.004]
[6]张宁,刘丰丽,马同胜,等.Ⅲ型先天性食管闭锁手术后吻合口漏的原因分析及处理策略[J].临床小儿外科杂志,2021,20(12):1127.[doi:10.12260/lcxewkzz.2021.12.005]
Zhang Ning,Liu Fengli,Ma Tongsheng,et al.Study on the causes and treatment strategies of anastomotic leakage after operation for type Ⅲ congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,2021,20(04):1127.[doi:10.12260/lcxewkzz.2021.12.005]
[7]冯众,沈淳.先天性食管闭锁患者手术后远期健康相关生活质量及评估方法的研究进展[J].临床小儿外科杂志,2021,20(12):1137.[doi:10.12260/lcxewkzz.2021.12.007]
Feng Zhong,Shen Chun.Research advances of long-term health-related quality-of-life and evaluation methods of congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,2021,20(04):1137.[doi:10.12260/lcxewkzz.2021.12.007]
[8]王雅琦,李万富,王海云.长段缺失型食管闭锁手术方式的应用现状与研究进展[J].临床小儿外科杂志,2021,20(12):1143.[doi:10.12260/lcxewkzz.2021.12.008]
Wang Yaqi,Li Wanfu,Wang Haiyun.Current status and research advances of surgical approaches for long-gap esophageal atresia[J].Journal of Clinical Pediatric Surgery,2021,20(04):1143.[doi:10.12260/lcxewkzz.2021.12.008]
备注/Memo
收稿日期:2019-08-03。
基金项目:上海市科委2019年度"科技创新行动计划"生物医药领域科技支撑项目指《长段缺失型食管闭锁"自吻合"装置的研发》(19441905500);上海市转化医学协同创新中心《复合力作用食管延长吻合装置的研发》(TM201910)
通讯作者:王俊,Email:wangjun@xinhuamed.com.cn