결론

LGEA 환자의 치료는 아직도 소아외과 영역의 주요 해결 과제로 남아있다.

PCM은 비교적 간단한 방법으로 문합부 장력을 감소시켜 문합부 누출의 위험성 을 낮추고 양 식도 간 일차 단단 문합을 시행할 수 있게 하는 유용한 술기이다.

LGEA 환아의 수술 시 PCM을 시행하여 문합부 누출의 발생은 없었으며, 협착의 발생률은 높았으나 수술적 치료 없이 간단한 부지 확장술로 증상이 호전될 수 있어 LGEA 환아의 수술에 있어 일차적으로 시도해 볼 수 있는 유용한 술기로 생각된다.

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참고문헌

1. Bagolan P, Iacobelli Bd B, De Angelis P, di Abriola GF, Laviani R, Trucchi A, Orzalesi M, Dall'Oglio L: Long gap esophageal atresia and esophageal replacement:

moving toward a separation? J Pediatr Surg 39: 1084-1090, 2004

2. Boyle EM, Jr., Irwin ED, Foker JE: Primary repair of ultra-long-gap esophageal atresia: results without a lengthening procedure. Ann Thorac Surg 57: 576-579, 1994 3. Chetcuti P, Phelan PD: Gastrointestinal morbidity and growth after repair of

oesophageal atresia and tracheo-oesophageal fistula. Arch Dis Child 68: 163-166, 1993

4. Chittmittrapap S, Spitz L, Kiely EM, Brereton RJ: Anastomotic leakage following surgery for esophageal atresia. J Pediatr Surg 27: 29-32, 1992

5. Depaepe A, Dolk H, Lechat MF: The epidemiology of tracheo-oesophageal fistula and oesophageal atresia in Europe. EUROCAT Working Group. Arch Dis Child 68:

743-748, 1993

6. Foker JE, Linden BC, Boyle EM, Jr., Marquardt C: Development of a true primary repair for the full spectrum of esophageal atresia. Ann Surg 226: 533-541; discussion 541-533, 1997

7. Giacomoni MA, Tresoldi M, Zamana C, Giacomoni A: Circular myotomy of the distal esophageal stump for long gap esophageal atresia. J Pediatr Surg 36: 855-857, 2001

8. Haight C: Congenital Atresia of the Esophagus With Tracheoesophageal Fistula : Reconstruction of Esophageal Continuity by Primary Anastomosis. Ann Surg 120:

- 12 -

9. Holder TM, Ashcraft KW, Sharp RJ, Amoury RA: Care of infants with esophageal atresia, tracheoesophageal fistula, and associated anomalies. J Thorac Cardiovasc Surg 94: 828-835, 1987

10. Hollands CM, Lankau CA, Jr., Burnweit CA: Preoperative home care for esophageal atresia--a survey. J Pediatr Surg 35: 279-281; discussion 282, 2000

11. Konkin DE, O'Hali W A, Webber EM, Blair GK: Outcomes in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 38: 1726-1729, 2003

12. Kontor EJ: Esophageal atresia with wide gap: primary anastomosis following Livaditis procedure. J Pediatr Surg 11: 583-584, 1976

13. Livaditis A, Bjorck G, Kangstrom LE: Esophageal myectomy. An experimental study in piglets. Scand J Thorac Cardiovasc Surg 3: 181-185, 1969

14. Livaditis A, Radberg L, Odensjo G: Esophageal end-to-end anastomosis. Reduction of anastomotic tension by circular myotomy. Scand J Thorac Cardiovasc Surg 6:

206-214, 1972

15. Ludman L, Spitz L: Quality of life after gastric transposition for oesophageal atresia.

J Pediatr Surg 38: 53-57; discussion 53-57, 2003

16. Okada A, Usui N, Inoue M, Kawahara H, Kubota A, Imura K, Kamata S:

Esophageal atresia in Osaka: a review of 39 years' experience. J Pediatr Surg 32:

1570-1574, 1997

17. Okamoto T, Takamizawa S, Arai H, Bitoh Y, Nakao M, Yokoi A, Nishijima E:

Esophageal atresia: prognostic classification revisited. Surgery 145: 675-681, 2009

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18. Ring WS, Varco RL, L'Heureux PR, Foker JE: Esophageal replacement with jejunum in children: an 18 to 33 year follow-up. J Thorac Cardiovasc Surg 83: 918-927, 1982

19. Ruangtrakool R, Spitz L: Early complications of gastric transposition operation. J Med Assoc Thai 83: 352-357, 2000

20. Schneeberger AL, Scott RB, Rubin SZ, Machida H: Esophageal function following Livaditis repair of long gap esophageal atresia. J Pediatr Surg 22: 779-783, 1987 21. Spitz L: Gastric transposition for esophageal substitution in children. J Pediatr Surg

27: 252-257; discussion 257-259, 1992

22. Spitz L: Esophageal atresia. Lessons I have learned in a 40-year experience. J Pediatr Surg 41: 1635-1640, 2006

23. Spitz L, Kiely E, Brereton RJ, Drake D: Management of esophageal atresia. World J Surg 17: 296-300, 1993

24. Tannuri U, Tannuri AC, Fukutaki MF, de Oliveira MS, Muoio VM, Massaguer AA:

Effects of circular myotomy on the healing of esophageal suture anastomosis: an experimental study. Rev Hosp Clin Fac Med Sao Paulo 54: 9-16, 1999

25. Tannuri U, Teodoro WR, de Santana Witzel S, Tannuri AC, Lupinacci RM, Matsunaga P, Matsumura N, Naufal RR: Livaditis' circular myotomy does not decrease anastomotic leak rates and induces deleterious changes in anastomotic healing. Eur J Pediatr Surg 13: 224-230, 2003

26. Touloukian RJ, Seashore JH: Thirty-five-year institutional experience with end-to-side repair for esophageal atresia. Arch Surg 139: 371-374; discussion 374, 2004

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Experience with proximal circular myotomy for congenital esophageal atresia

Treatment of long-gap esophageal atresia(LGEA) remains a major challenge in pediatric surgery. The aim of this study is to report the utility of the proximal circular myotomy(PCM) in case of LGEA repair. Between 1994 and 2011 medical record of patients with a diagnosis of esophageal atresia in Ajou university school of medicine were reviewed. The total number of patients was 39, esophageal atresia with distal treacheoesophageal fistula(Gross type C) was 37. Twelve cases received a single or double PCM and primary end-to-end anastomosis(group I). Twenty-two cases received primary end-to-end anastomosis without PCM(group II). Two anastomotic leakages occurred in group II(10.5%).

There was no anastomotic leakage in group I(0.0%). Three Strictures occurred in group II(15.8%). Nine Strictures occurred in group I and all patients were improved after bougienage. PCM for LGEA is feasible procedure. We suggest that PCM may be favored as treatment option for LGEA.

Keyword : Congenital esophageal atresia, long-gap, proximal circular myotomy, anastomotic leakage, esophageal stricture, bougienage