AIM:There is still no consensus about the optimal surgical approach for esophageal replacement in the case of long-gap esophageal atresia (LGEA) or extensive corrosive strictures. The aim of this article was to perform a meta-analysis comparing the most widely used techniques for esophageal replacement in children: jejunal interposition (JI), colon interposition (CI), and gastric pull-up (GPU). METHODS:Review of the English-language literature published in the past 5 years about esophageal replacement in children was done. The focus was on postoperative survival rate, morbidity (gastrointestinal complications such as anastomotic stenosis/leakage and respiratory complications such as pneumothorax, pneumonia, and atelectasis), and long-term follow-up when available. Among long-term gastrointestinal outcomes were dysphagia, reflux, and dumping; among long-term respiratory outcomes were recurrent pneumonia and recurrent aspiration leading to chronic lung disease. Data were computed by Comprehensive Meta-Analysis software (Version 2.2.064). MAIN RESULTS:A total of 15 studies (4 comparative retrospective, 8 retrospective, and 3 prospective) including 470 patients (264 LGEA) were identified; 344 (73%) patients underwent CI, 99 (21%) GPU, and 27 (6%) JI. Among these 15 studies, 9 provided data about long-term follow-up. CONCLUSION:Proper prospective comparative studies are lacking. GPU and CI appear comparable regarding postoperative mortality, anastomotic complications, and graft loss. On the long-term, GPU seems to be associated with a higher respiratory morbidity but fewer gastrointestinal complications than CI. Based on this article only two series provide data about JI, and they show highly divergent results. JI appears to be a valid replacement technique when performed by experienced centers; however larger numbers are needed to assess the outcomes of this procedure.

译文

目的:对于长间隙食管闭锁(LGEA)或广泛的腐蚀性狭窄,对于食管置换的最佳手术方法尚无共识。本文的目的是进行一项荟萃分析,比较儿童中最广泛使用的食道置换技术:空肠置入(JI),结肠置入(CI)和胃上拉(GPU)。
方法:对近5年来发表的有关儿童食管置换术的英语文献进行回顾。重点是术后生存率,发病率(胃肠道并发症,如吻合口狭窄/渗漏和呼吸道并发症,如气胸,肺炎和肺不张),以及长期随访(如适用)。长期胃肠道疾病包括吞咽困难,反流和倾倒。长期呼吸结果包括复发性肺炎和反复吸入导致慢性肺部疾病。数据通过综合荟萃分析软件(版本2.2.064)进行计算。
主要结果:共鉴定了15项研究(4项比较回顾性研究,8项回顾性研究和3项前瞻性研究),包括470例患者(264 LGEA)。 344(73%)名患者接受了CI,99(21%)名GPU和27(6%)JI。在这15项研究中,有9项提供了有关长期随访的数据。
结论:缺乏适当的前瞻性比较研究。 GPU和CI在术后死亡率,吻合并发症和移植物丢失方面具有可比性。从长远来看,GPU似乎与CI相比具有更高的呼吸系统发病率,但胃肠道并发症更少。基于本文,只有两个系列提供了有关JI的数据,并且它们显示出截然不同的结果。由经验丰富的中心执行时,JI似乎是一种有效的替换技术;但是,需要更多的数字来评估此过程的结果。

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