一项长期随访研究显示,大约 80% 在婴儿时期接受过 OA/TOF 矫正手术的成人患者主诉不同程度的吞咽困难的症状。虽然许多人表示这并不影响他们的整体生活质量或食物选择,但是 13% 的患者需要通过内镜取出异物。[24]Gibreel W, Zendejas B, Antiel RM, et al. Swallowing dysfunction and quality of life in adults with surgically corrected esophageal atresia/tracheoesophageal fistula as infants: forty years of follow-up. Ann Surg. 2017 Aug;266(2):305-10.http://www.ncbi.nlm.nih.gov/pubmed/27607100?tool=bestpractice.com 在一项研究中,58%在新生儿期接受过治疗的患者成年后有胃食管反流病。[25]Taylor AC, Breen KJ, Auldist A, et al. Gastroesophageal reflux and related pathology in adults who were born with esophageal atresia: a long-term follow-up study. Clin Gastroenterol Hepatol. 2007 Jun;5(6):702-6.http://www.ncbi.nlm.nih.gov/pubmed/17544997?tool=bestpractice.com GORD 是由食管动力较差和先天性短食管所致。一项研究在对患者进行了 10 年的随访后,通过压力测定发现 100% 的患者都存在食管动力障碍。[26]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 Gastrointest Surg. 2017 Jun;21(6):927-35.http://www.ncbi.nlm.nih.gov/pubmed/28424985?tool=bestpractice.com 最初的治疗方法是药物治疗,但是50%的患者需要抗反流治疗。[12]Geneviève D, de Pontual L, Amiel J, et al. An overview of isolated and syndromic oesophageal atresia. Clin Genet. 2007 May;71(5):392-9.http://www.ncbi.nlm.nih.gov/pubmed/17489843?tool=bestpractice.com[27]Holcomb GW 3rd, Rothenberg SS, Bax KM, et al. Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis. Ann Surg. 2005 Sep;242(3):422-8.http://www.ncbi.nlm.nih.gov/pubmed/16135928?tool=bestpractice.com[28]Shaw-Smith C. Oesophageal atresia, tracheo-oesophageal fistula, and the VACTERL association: review of genetics and epidemiology. J Med Genet. 2006 Jul;43(7):545-54.http://www.ncbi.nlm.nih.gov/pubmed/16299066?tool=bestpractice.com[29]Koivusalo A, Pakarinen MP, Rintala RJ. The cumulative incidence of significant gastrooesophageal reflux in patients with oesophageal atresia with a distal fistula - a systematic clinical, pH-metric, and endoscopic follow-up study. J Pediatr Surg. 2007 Feb;42(2):370-4.http://www.ncbi.nlm.nih.gov/pubmed/17270551?tool=bestpractice.com[30]Buford JM, Dissinger MS, Copeland DR, et al. Repair of esophageal atresia with tracheoesophageal fistula via thoracotomy: a contemporary series. Am J Surg. 2011 Aug;202(2):203-6.http://www.ncbi.nlm.nih.gov/pubmed/21810502?tool=bestpractice.com 考虑到持续性食管炎的发病率,需要在 OA/TOF 修复术后对 GORD 进行长期监测。一项研究发现,这类患者的肠上皮化生发病率比一般儿科患者高 10 倍。[31]Hsieh H, Frenette A, Michaud L, et al. Intestinal metaplasia of the esophagus in children with esophageal atresia. J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):e1-4.http://www.ncbi.nlm.nih.gov/pubmed/28248794?tool=bestpractice.com
Disorders of infant feeding
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