Thoracic skeletal anomalies following surgical treatment of esophageal atresia. Lessons from a national cohort.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Bastard François, Bonnard Arnaud, Rousseau Véronique, Gelas Thomas, Michaud Laurent, Irtan Sabine, Piolat Christian, Ranke-Chrétien Aline, Becmeur François, Dariel Anne, Lamireau Thierry, Petit Thierry, Fouquet Virginie, Le Mandat Aurélie, Lefebvre Francis, Allal Hossein, Borgnon Josephine, Boubnova Julia, Habonimana Edouard, Panait Nicoleta, Buisson Philippe, Margaryan Marc, Michel Jean-Luc, Gaudin Jean, Lardy Hubert, Auber Frédéric, Borderon Corinne, De Vries Philine, Jaby Olivier, Fourcade Laurent, Lecompte Jean François, Tolg Cécilia, Delorme Benoit, Schmitt Françoise, Podevin Guillaume
Аннотация
MATERIALS AND METHODS: Pediatric surgery departments from our national network were 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.
LEVELS OF EVIDENCE: Level III retrospective comparative treatment study.