Seventeen Years' Experience with Ninety-six Esophageal Atresias

선천성 식도 폐쇄증 - 17년간의 96예 치험 분석 -

To study the clinical profiles and outcome of surgery in infants with esophageal atresia, we reviewed 96 esophageal atresia cases who were treated from April, 1978 to June, 1995. There were 51 male and 45 female infants, a ratio of 1.1:1. The low birth weight(<2500g) patients were 32%. Clinical findings at the time of diagnosis included drooling in 57%, choking in 50%, cyanosis in 38%, respiratory distress in 27% and swallowing difficulty in 20%. Gross classification included 6 cases of type A esophageal atresia(6%), 79 cases of type C(82%), 3 cases of type E (3%) and 8 cases of type F(8%). Associated anomalies occurred in 34 infants(35%). Among them, cardiac anomalies were most common(60%). A primary repair of the defect was carried out in 76 patients with type A or C. A staged operation comprising a repair or gastric tube interposition after gastrostomy was performed in 8 patients. In all 3 infants with H-type, a division of fistula was performed. Esophageal resection and anastomosis was done in 8 infants with esophageal stenosis. In one infant, a gastrostomy was performed and he expired before staged operation. Anastomotic complications included leakage in 16 cases(17%), stricture in 37 cases(39%) and recurrent tracheoesopohageal fistula in 3 cases(3%). The mortality rate was 14% and the leading cause of death was pneumonia. The overall survival rate was 86%, and according to Waterston criteria, the survival rates were 93%, 85% and 58% in class A, Band C, respectively. 75 patients were followed up with median follow up 6.4 years. Among them, 93% were uneventful and 7% had frequent pneumonia.

저자들은 96예의 선천성 식도 폐쇄를 분석하여 다음의 결과를 얻었다. 1) 남녀비는 1.1:1로 비슷하였다. 2) 출생시 평균 체중은 2.8kg 였고 2.5kg 미만의 저출생 체중아가 32.3%를 차지했다. 3) 주증상은 타액 분비 과다, 수유시 호흡 곤란, 청색증 등이었다. 4) Gross 분류법에 의한 해부학적 유형은 Type C가 가장 많은 빈도로 관찰되었다(82.3%). 5) 동반 선천성 기형이 35%에서 관찰되었고 이 중 심장 기형이 가장 많은 빈도로 관찰되었다(60%). 6) 수술은 Type A, C의 경우 일차적 문합을 시행하였고 일차적 문합이 불가능한 원간격 결손 환아에서 역위관 삽입술이 시행되었다. Type E(H-type)의 경우 식도기관루 절제술이, Type F의 경우 식도협착부위 절제 및 단단 문합술이 시행되었다. 7) 수술후 주요 합병증은 문합부 누출, 문합부 협착, 기관 식도루 재발 등이었다. 8) 생존율은 86%였고 Waterston Criteria에 따른 생존율은 Class A, 93%, Class B, 86%, Class, 58%였다. 9) 추적 조사 결과 93%의 환아가 건강했고 7%의 환아가 잦은 호흡기 감염으로 입원한 병력이 있었다.