Wang Jun.An in-depth understanding of perioperative complications of congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,2021,20(12):1101-1107.[doi:10.12260/lcxewkzz.2021.12.001]
先天性食管闭锁围手术期并发症的深度认识
- Title:
- An in-depth understanding of perioperative complications of congenital esophageal atresia
- 关键词:
- 食管闭锁/先天性; 手术中并发症/治疗; 手术后并发症/外科学; 手术后并发症/治疗
- Keywords:
- Esophageal Atresia/CN; Intraoperative Complications/TH; Postoperative Complications/SU; Postoperative Complications/TH
- 分类号:
- R571;R726.1
- 摘要:
- 随着先天性食管闭锁临床诊治技术的推广及其应用能力的提高，该病治愈率在我国得到了显著提升。但是伴随而来的各种围手术期并发症以及后遗症的发生率也逐渐提高，给患者远期生活质量带来严重影响。本文从一些易被人们忽视的围手术期并发症切入，按照术前并发症如吸入性肺炎和肺部感染、胃穿孔，术中并发症如胸腔镜手术相关高碳酸血症和酸中毒、麻醉相关并发症、手术操作相关并发症，术后并发症如食管扩张致食管破裂引起食管漏、食管气管瘘漏诊或复发、声带功能障碍、气管软化，结合国内外文献以及国内多家医疗机构的临床诊治经验逐一阐述。重点分析了并发症的产生原因以及严重后果，提出针对性治疗策略，尤其是对一些疑难并发症的认识与处理，以及一些可能被大家忽视的气道相关并发症、吞咽功能及远期生活质量问题，提出了可行性的预防与诊治建议，以期为提高食管闭锁综合治疗水平，改善患者自婴幼儿起至成年后的生活质量提供参考。
- 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.
参考文献/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.
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备注/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