Thoracic skeletal anomalies following surgical treatment of esophageal atresia. Lessons from a national cohort

被引:34
作者
Bastard, Francois [1 ]
Bonnard, Arnaud [2 ]
Rousseau, Veronique [3 ]
Gelas, Thomas [4 ]
Michaud, Laurent [5 ]
Irtan, Sabine [6 ]
Piolat, Christian [7 ]
Ranke-Chretien, Aline [8 ]
Becmeur, Francois [9 ]
Dariel, Anne [10 ]
Lamireau, Thierry [11 ]
Petit, Thierry [12 ]
Fouquet, Virginie [13 ]
Le Mandat, Aurelie [14 ]
Lefebvre, Francis [15 ]
Allal, Hossein [16 ]
Borgnon, Josephine [17 ]
Boubnova, Julia [18 ]
Habonimana, Edouard [19 ]
Panait, Nicoleta [20 ]
Buisson, Philippe [21 ]
Margaryan, Marc [22 ]
Michel, Jean-Luc [23 ]
Gaudin, Jean [24 ]
Lardy, Hubert [25 ]
Auber, Frederic [26 ]
Borderon, Corinne [27 ]
De Vries, Philine [28 ]
Jaby, Olivier [29 ]
Fourcade, Laurent [30 ]
Lecompte, Jean Francois [31 ]
Tolg, Cecilia [32 ]
Delorme, Benoit [1 ]
Schmitt, Francoise [1 ]
Podevin, Guillaume [1 ]
机构
[1] Univ Hosp, 4 Rue Larrey, F-49933 Angers, France
[2] Robert Debre Univ Hosp, 48 Bd Serrurier, F-75019 Paris, France
[3] Necker Univ Hosp, 149 Rue Sevres, F-75015 Paris, France
[4] Mere Enfant Univ Hosp, 59 Bd Pinel, F-69500 Bron, France
[5] Jeanne Flandre Univ Hosp, Ave Eugene Avinee, F-59037 Lille, France
[6] Trousseau Univ Hosp, 26 Rue Arnold Netter, F-75571 Paris 12, France
[7] Grenoble Univ Hosp, Pole Couple Enfant, Ave Maquis Gresivaudan, F-38700 La Tronche, France
[8] Nancy Univ Hosp, 5 Rue Morvan, F-54500 Nancy, France
[9] Hautepierre Univ Hosp, 1 Ave Moliere, F-67200 Strasbourg, France
[10] Univ Hosp, 7 Quai Moncousu, F-44000 Nantes, France
[11] Pellegrin Univ Hosp, Pl Amelie Raba Leon, F-33000 Bordeaux, France
[12] Univ Hosp, Ave Cote Nacre, F-14033 Caen, France
[13] Univ Hosp, 78 Rue Gen Leclerc, F-94275 Le Kremlin Bicetre, France
[14] Univ Hosp, 330 Ave Grande Bretagne, F-31059 Toulouse 9, France
[15] Amer Mem Hosp, 47 Rue Cognacq Jay, F-51092 Reims, France
[16] Lapeyronie Univ Hosp, 371 Av Doyen Gaston Giraud, F-34090 Montpellier, France
[17] Univ Hosp, 14 Rue Paul Gaffarel, F-21000 Dijon, France
[18] La Timone Univ Hosp, 264 Rue St Pierre, F-13385 Marseille, France
[19] Sud Univ Hosp, 16 Blv Bulgarie, F-35000 Rennes, France
[20] Nord Univ Hosp, Chemin Bourrely, F-13915 Marseille 20, France
[21] Amiens Univ Hosp, Ave Rene Laennec, F-80480 Salouel, France
[22] Hosp Ctr, 194 Ave Rubillard, F-72037 Le Mans, France
[23] Felix Guyon Hosp, Allee Topazes, F-97400 La Reunion, France
[24] Univ Hosp, 2 Rue Miletrie, F-86000 Poitiers, France
[25] Clocheville Univ Hosp, 49 Blvd Beranger, F-37000 Tours, France
[26] Univ Hosp, 2 Pl St Jacques, F-25000 Besancon, France
[27] Univ Hosp, 58 Rue Montalembert, F-63000 Clermont Ferrand, France
[28] Univ Hosp, 2 Ave Foch, F-29000 Brest, France
[29] CHIC, 40 Av Verdun, F-94000 Creteil, France
[30] Univ Hosp, 2 Ave Martin Luther King, F-87000 Limoges, France
[31] Lenval Hosp, 57 Ave Calif, F-06200 Nice, France
[32] Univ Hosp, Fort De France, Martinique, France
关键词
Esophageal atresia; Thoracic wall; Thoracotomy; Thoracoscopy; TRACHEOESOPHAGEAL FISTULA; THORACOSCOPIC REPAIR; THORACOTOMY;
D O I
10.1016/j.jpedsurg.2017.07.013
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Introduction: Thoracotomy as surgical approach for esophageal atresia treatment entails the risk of deformation of the rib cage and consequently secondary thoracogenic scoliosis. The aim of our study was to assess these thoracic wall anomalies on a large national cohort and search for factors influencing this morbidity. Materials and methods: Pediatric surgery departments fromour national networkwere asked to send recent thoracic X-ray and operative reports for patients born between 2008 and 2010 with esophageal atresia. The X-rays were read in a double-blind manner to detect costal and vertebral anomalies. Results: Among 322 inclusions from 32 centers, 110 (34.2%) X-rays were normal and 25 (7.7%) displayed thoracic malformations, including 14 hemivertebrae. We found 187 (58.1%) sequelae of surgery, including 85 costal hypoplasia, 47 other types of costal anomalies, 46 intercostal space anomalies, 21 costal fusions and 12 scoliosis, with some patients suffering from several lesions. The rate of patients with these sequelae was not influenced by age at intervention, weight at birth, type of atresia, number of thoracotomy or size of the center. The rate of sequelae was higher following a classical thoracotomy (59.1%), whatever the way that thoracotomy was performed, compared to nonconverted thoracoscopy (22.2%; p = 0.04). Conclusion: About 60 % of the patients suffered from a thoracic wall morbidity caused by the thoracotomy performed as part of surgical treatment of esophageal atresia. Minimally invasive techniques reduced thoracic wall morbidity. Further studies should be carried out to assess the potential benefit of minimally invasive approaches to patient pulmonary functions and on the occurrence of thoracogenic scoliosis in adulthood. (c) 2017 Elsevier Inc. All rights reserved.
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收藏
页码:605 / 609
页数:5
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