Purpose

Recent studies have identified transanastomotic tubes (TATs) as a risk factor for the development of anastomotic strictures after repair of esophageal atresia with tracheoesophageal fistula (EATEF). We further investigated these findings in a multicenter study.

Methods

We conducted a retrospective cohort study at three university-affiliated hospitals in the province of Quebec. All patients with types C and D EATEF who underwent primary repair between January 1993 and August 2018 were included. Anastomotic stricture was defined as clinical symptoms of stricture with confirmation on esophagram or endoscopy. Multivariate logistic regression and the Wilcoxon Rank-Sum test were used to evaluate the primary outcome of stricture within one year of surgery and secondary outcome of duration of postoperative total parenteral nutrition (TPN).

Results

244 patients were included, of which 234 (96%) were type C and 10 (4%) were type D. The anastomotic stricture rate at 1 year was 30%. TATs were utilized in 61% of patients. Thirty-six percent of patients with TATs developed a stricture within one year, as compared to 19% of patients without TATs (p = 0.005). TATs were associated with stricture on univariate analysis (OR 2.49, p = 0.004, 95% CI: 1.37–4.69). On multivariate analysis, after adjusting for gestational age, birth weight, leak, long gap, anastomotic tension, and daily acid suppression, patients with TATs had 2.72 times higher odds of developing a stricture as compared to patients without TATs (p = 0.006, 95% CI: 1.35–5.74). The median duration of TPN was 9 days in both groups (p = 0.139, IQR 6–14 in patients with TATs versus IQR 7–16 in patients without).

Conclusion

Transanastomotic tubes are associated with a significantly higher risk of postoperative stricture following repair of esophageal atresia with tracheoesophageal fistula and do not shorten the duration of total parenteral nutrition.

Level of evidence

III.

中文翻译：

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经吻合口饲管对食管闭锁和气管食管瘘患者吻合口狭窄的影响：魁北克经验

目的

最近的研究已确定经吻合管 (TAT) 是食管气管瘘 (EATEF) 修复食管闭锁后发生吻合口狭窄的危险因素。我们在一项多中心研究中进一步调查了这些发现。

方法

我们在魁北克省的三所大学附属医院进行了一项回顾性队列研究。纳入 1993 年 1 月至 2018 年 8 月期间接受一期修复的所有 C 型和 D 型 EATEF 患者。吻合口狭窄被定义为食管造影或内镜检查证实的狭窄的临床症状。多因素logistic回归和Wilcoxon秩和检验用于评估手术一年内狭窄的主要结果和术后全肠外营养（TPN）持续时间的次要结果。

结果

共纳入244例患者，其中C型234例（96%），D型10例（4%）。1年吻合口狭窄率为30%。61% 的患者使用了 TAT。36% 的 TAT 患者在一年内出现狭窄，而没有 TAT 的患者为 19% ( p  = 0.005)。TAT 与单变量分析的狭窄相关（OR 2.49，p  = 0.004，95% CI：1.37–4.69）。在多变量分析中，在调整胎龄、出生体重、漏气、长间隙、吻合口张力和每日抑酸后，与没有 TAT 的患者相比，有 TAT 的患者发生狭窄的几率高 2.72 倍（p  = 0.006, 95 % CI：1.35–5.74）。两组 TPN 的中位持续时间为 9 天（p = 0.139，有 TAT 的患者 IQR 6-14 而没有 TAT 的患者 IQR 7-16）。

结论

经吻合管与气管食管瘘修复食管闭锁术后狭窄的风险显着增加相关，并且不会缩短全胃肠外营养的持续时间。

证据水平

三、