= Abstract =
~j ~ ~J ~ s=.. ~l Sll ~
-171.-J7J~ 96~1 ;7;1~ *~-Seventeen Years' Experience with Ninety- six Esophageal Atresias
Yang-Soon Chun, M.D., Sung-Eun Jung, M.D., Soong-Cheal Lee, M.D., Kwi-Won Park, M.D. and Woo-Ki Kim, M.D.
Department of Surgery, Seoul National University College of Medicine Seoul, Korea
To study the clinical profiles and outcome of surgery
in infants with esophagealatresia, we reviewed 96 esophageal atresia cases
whowere 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 diagnosisinculded drooling in 57%, choking in 50%, cyanosis in 38%, respiratory distress in 27%
and swallowing difficulty in 20
%.Gross classification
included6 cases of type A esophageal atresia(6%)
, 79 cases of type C(82%). 3 cases of type E (3%) and 8 casesof type F(8%). Associated anomalies occurred in 34
infants(35%).Among them, car- diac 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
infantswith H-type, a division of fistula
wasperformed. Esophageal resection and anasto- mosis was done in 8 infants with esophageal stenosis. In one infant, a gastrostomy was performed and he expired before staged operation. Anastomotic complications incuded leakage
in16 cases(l7%), stricture in 37 cases(39%) and recurrent tracheoesopohageal fistula in 3 cases(3%). The mortality rate was 14% and the lead- ing cause of death was peumonia. The overall survival rate was 86%, and according to Waterston cirteria, 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.
Index Words:Esophageal atresia
~ 1=-~-€:- 1992\1.£ "'~%qj~:ll!.~~ ~Tll]2J ~ o].!f-<>l1:i%
~ ::=-~-€:- 1995\1.£ L1l~.2j~~j:j .:}7-1] ~~L1lj:joJl"'~ ".}.li~~%
Haightl7} 1941\1 ~3':s.. ~~Aj 6.).s:. iEllj:)]~
~ 71:ii:\-6.).s:.~ ~o}~ Aj~"i.2..s.. ;:;'Ili~ 0lcjJ 711 4i-"i~ ;:;'1li~9.j ~~01 9l~q.
~71 {It:!:.2..s.. %~Ad iEl1t:g9.j -'f1~.s:.7} '7t0}~Jl
2.3.4 ~tJ1"i~ ~.llL~ ~AgO} :ii:\-c.l5!.. ~tH 1500g 01<'>} A~~~1%0}9.j Age 01 7}-'6-<'>}711 ~~q567.
T-?l tlJ~9.j ~~5!.. 01 ~~9.j %~%Jl} J..}uJ%
01 ~~~o-j ~AH Til.. A}uJ -'tl~.2..5!..A~ ~~'Vd ~ .s:. ililj:)] A}~~17} o}\::! %'t!- 71~, ~<'>I ~AJ 71"&j01 tJ1~~Jl 9lc}.89 °1t.'~~ ;:;'1~"i~ %'t!- 71"&jojl tJ1
~ ~A~~ ~T2.J- "i~"i~ ;:;,lli7} -tl~Ad ~.s:. ili1 j:)]~9.j tJ~ %~% ~ A}uJ%% ~~}..171c.l2.j- A}
li~ c}.
A~A}~.g. -tl~Ad ~.s:. iEl1j:)]~9.j ~JAJ"i ~Acl%
0.,to}.!i.Jl T-?l ~ ~Jl} %% ~~tl1 .!i.71 -'f1tH ~
~T~ A1~g~c}.
1978\1 4-%l.-!f-E~ 1995\1 6-%l.7J}:A.1 }..~%tJ1~.llL ~ -'tl ~o}.2.jJl}ojH Y-?l~.g. 104"119.1 -tl~Ad ~.s:. ili1 j:)]~ ~o}% % 9.j.!j!-71~ ~~01 7}-'6-~r;j 96"119.1
~o}%~ tJ1AJ.2..5!.. 9.j.!j!-71~% ~~<'>}e:j ~tJ"i ~ AJ Jl~~ }..1~~<'>}';?;.C}.
'J o} 43"11. e:jo} 40"11 5!..}..~ 'J1..:j1l1-c 1.1:1 01
~c}(.R 1).
Table 1. Distribution by the Sex Sex
Male Female Total
No. (%)
51 (53.1)
45 (46.9) 96 (100.0)
J,jA, ~~I%o}-c 1.1kg .2..5!..A~ "2}AgO} % ~~01~
Jl ~ Jl ~~I %o}-c 3.9kg .2..5!..A~ ~Ag AI ITa 'IT ~~1 % .g. 2.8kg ';?;.c}. 2.5kg u1 uJ.«.1 A~~Ag ~~1%0}7} 32.
3'10~ ~}:A.mq(.R 2).
Table 2. Brith Weight
Birth weight(g) No. (%)
~ 1500 2 ( 2.1)
1501-2000 6 ( 6.2)
2001- 2500 23 ( 24.0)
>2500 65 ( 67.7)
Total 96 (l00.0)
3. ~~ g~
T-?l~ Til.. ~AJ ~AJ.g. E}<ell ~1l1Jl}q 55"11 (57.3%), T%A1 ~%~~ 45"11 (46.9%), ;<a~~
36"11(37.5%), ~%~~ 26"11(27.1%), ~<,>}~~
20"11(20.8%)';?;.c}(.R 3).
Table 3. Clinical Manifestations
Symptoms No. %
Drooling 55 (57.3)
Choking after feeding 45 (46.9 )
Cyanosis 36 (37.5)
Respiratory difficulty 26 (27.1 )
Swallowing difficulty 20 (20.8 )
Gross ~*~ojl u:};: ~s:. ili1j:)] %~.g. ~s:. ili1 j:)] uJ 9l-c 7,S.!f-(type A) 6"11 (6.3 % ), ~ s:. ilil j:)] 2.J-
~-'f1-!f- 71:ii:\-~s:.~7} %~~ 7,S.!f-(type C) 79"11 (82.3%), ~s:. ili1j:)] ~01 71:ii:\-~s:.~uJ 9l-c H- type(type E) 3"11 (3.1 %), -tl~Ad ~-'f1-!f- ~s:. ~ .3} (type F) 8"11 (8.3% )';?;.Jl -6.)s:. ililSll2.J- -2--'f1-!f- 71:ii:\-~s:.~7} %~~ 7,S.!f- (type B), ~-'f1-!f-2.J- -2- -'f1-!f- 0J~ 71:ii:\--6.)s:.~7} %'t!-~ 7,S.!f- (type D) -c
~7,j<'>}:A.1 *<'>mc}(.R 4).
Table 4. Type of Anomaly(Gross classification56)
Anomaly No. %
A. EA without TEF 6 ( 6.3)
B. EA with proximal TEF 0
C. EA with distal TEF 79 ( 82.3)
D. EA with double TEF 0
E. TEF without EA(H-type) 3 ( 3.1) F. Congenital esophageal stenosis 8 ( 8.3)
Total 96 (100.0)
Table 5. Associated Anomalies
No. (%)
Congenital heart disease 24 (60.0 )
Imperforate anus 6 (15.0)
Gastroin test ina I 2 ( 5.0)
Antral web ( 2.5)
Duoderal aresia 1 ( 2.5)
Bony anomalies 8 (18.0)
Cleft palate 5 (12.0)
Polydactyly 2 ( 5.0)
Syndactyly ( 2.5)
Total 40 (100.0)
Table 6. Surgical Procedures
Anomaly type A (6)
C (78)
E (3)
F (8)
GT : gastrostomy
Initial Primary repair( 1 ) GT(3)
CE and GT(1)
Primary repair(75) GT(3)
Fistula devision ( 3 )
Resection & anastomosis ( 6 ) GT(2)
CE : cervical esophagostomy
919iq.
%~ 7]~91 -;--ff-.£e ~7.J 7]~ 24oJ], ±ll~Jo] 6 oj], ~~7]1l] 7]~ 2oJ], ~Zjll] 7]~ 8oJ]~qOl
5 ).
~ 5:. ill] ±ll iF~ oj] u:j-~ -Y-'€ lolJ
ttl
~ if. 6 oj] 7] -'€~6j 91q. Type A 6oJ]91 ~~ loJ]e ~~t.3"j ~ -y-,€~ A]t;~i>}~.:u. 5oJ]e~A~ .!fl.!f--'€ A]t;~~ o]~t -y-,€.£A~, 3oJ]e ~~}.3"j ~-y-,€o] 2oJ]e ~.!fl~ 7-1
~]-,€o] A]t;~~9iq. Type C 78oJ]91 ~~ 75 oj] ::
~~}.3"j ~-y-,€~ A]t;~i>t~.:u. 3oJ]e .!fl.!f--'€ A]t;~~
0] ~t-Y-'€ .£A~ 1 oj] oJ]A~:: ~.!fl~ 7-j;'.]-,€o] 2 oj] oJ]A~
e ~~}.3"j ~-y-,€o] Alt;~~9iq. Type E(H-type) 3oJ]e .£.-'¥- 7]~~5:..!f- 7.J;ljl-,€o] A]t;~~9i.:u. Type Fe ~;3} .!f-.!fl ~5:. 1i;lj]-,€ ~ ~-Y0l A]-t;~~9iq.
.£.~ ~At~ ~ 7t'o~ ~
=;12f91
~il.£ -Y-'€~A]i5~~.Q.t9 -Y-'€~ 7~~~ ~5:. ~oa-'€0ly. methy- lene blue tesV·J -'T-*o] ~e ?,;! ~ ~«}i>t.:u. %~~
;Ij]7-1i>mq.. -Y%e ~-Y.!f- -'T-*ol ~e ?,;!°l ~«}
¥!
~ A] ~i>}~ q..Treatment
Secondary
Primary repair(2) Reversed gastric tube (1) Reversed gastric tube (1)
Reversed gastric tube (1) Primary repair(2)
Resection & anastomosis (2)
Table 7. Postoperative Complications
Complcation Initial therapy Result Additional Therapy Result Anastomotic Conservative Improved(lS)
leackage(l6 ) management Expired(l)
Anastomotic Balloon Improved (23)
stricture( 37) dilatation(30) Stationary(5) R & A(5) Improved( 3) Expired(2) Expired(2)
Bougienation( 6) Improved ( 4)
Stationary(2) R & A(2) Improved(l ) Expired( 1) Esophagoplasty( 1) Improved( 1)
Recurrent
tracheo- Improved (2)
esophageal Revision (3) Recur & expire(l) fistula(3)
*
R & A : resection and anastomosisE~)..~ ~~l~~Jl lcj]c
if-l-
~ .!ill'€l"6'-.Q..5!. )..}uJ-"5}~q.
~W.!f- ~:3f~ T~+ 7~~~ )"]ii~~ ~£ ~oa~
AJ- 37cj] (38.5%) oj])..~ ~7,'!~~Jl 23cj]c l~
Y1
A1 3~9.J %{i ~f<J-~~ ~{!~~Jl 4cj]c bougie
~;<'J-~ .Q.~ ~{!~~q. lcj1c %{i ~;<.J-~olY
bougienation ~ )..lii~"5}A] ?iJl l:l}~ ~£ Aa-os~
~ A1ii~"5}O:j ~{!~~q. 2cj1c
%"'a
~AJ-~9.J W~ ~.Q.~ )..}uJ-"5}~Jl %{i ~;<J-~~ ~{!~A1 ?i~
g
301]~ AnT~~ ~£ 1i~] ~ ~~ ~W~~ A1ii~<5-}O:j 3cj]~ ~{!~~Jl 2cj1c T~+ z{z{ llllra :l!} AJ-.!f- ~VJ-~ *'€l.9.J W~"6'-.Q.~ )..}uJ-"5}~q. ~
~ %{i ~;<.J-~9.J W~~.Q.~ )..}uJ-~ 2cj]~ ~~%.!f
E.~ T~% A1t5~~ lcj1~ ~].2j"5}1i':! AnT~o] ~.R~
~.£9.J -61£ ~3f~ 3401] %- 7cj]~)..~ 20.5%~q.
~~~ 71~1~~ A]ii~~ 3cj1 %- 2cj]c ~~.!f- ~:t!
~:3f.Q.~ ~~ Aa-os~ + ~{!~~q.
7]~-61£3f- An~~ 3cj](4%) oj])..~ 'V-~cr;~l ::J.
%- 2cj]c AnT~~ ~{!~~Jl lcj]c AnT~~ A]
t5~ ~.Q.Y-
An
~"5}O:j .!ill '€l ~.Q..5!. )..}uJ-"5}S1 q( R7).
~W.!f- 4'-*:l!} ~W.!f- ~:3f0] %Jt}~ 7.H-c 11 cjmq.
13cj] (17 %) 9.J )..}uJ- :@O}7} 91 <>1)..~ ).~ ~~.g. 86.
5%~q. )..}uJ- ~~.Q.~~ lll]ra llcjl, ~W.!f- 4'-*
~ ~~
if-l-
lcjl, %-~%~ lcj1 ~q(R 8).9. Wasterston Criteria
:@O ~ ~.g. Waterston Criteria oj1 u:}2.} ~-ff-"5}O:j ).~~%% ~~"6\l li!..1i':! A:;t 43cj1 (47.8%) 'F 301]
7} )..}uJ-"5}O:j ).~~% 93%, B:;t 35cj](38.9%) 'F 5cj17} )..}uJ-"5}O:j ).~~% 85.7%, C"ir 12cj] (13.3%) 'F 5cj17} )..}uJ-"5}O:j ).~~% 58.3%~q(R 9).
Table 8. Causes of Death Causes
Pneumonia Empyema Mediastimitis
No.
11 1 1
-143-
· Ttlble 9. Waters ton Risk Groups and Survival Survival Group Description
A BW>2500g and well B BW 1800-2500g and
well or
BW> 2500g with mod- erate anomaly or pneumonia
C BW<1800g or BW>1800g with se-
vere anomaly or pneumonlu
BW: birth wei'ght
No.( %) 43(47.8)
35(38.9)
12(13.3) rales(%)
93.0 85.7
58.3
75oJ]9.J ~o}oj]Ai ~-3:j ~A7} 7}~i5t(i!H:·t:-l] ~-3:j
7]7,}9.J 'F0J~~ 6.4\1o]~q. 39oJ](78.7%)9.J ~
°t7} -3i?8~ ~]'F ~7}~ .!!o]ni ;ct7Ji5t71] At~JI
HoJ] (14.7%)9.J ~0}7t ~~:£ Qoj-ff- '~P'Jg .!!S1
~ 4 t.Jl4.3j ;<']li oj]
1£
1(!-g i5tS1JI 5oJ] (6.6 % ) 9.J~0}7} 1(!-*.3j ~%7] {}~~£. '?J~~ ~~o] 'V.
~q.
1Hi~ -61:£ 3!l]~9.J ~Jt!~H -"g-eAt%~ 1939\1
~1(!-oj] Leven14 4 Ladd15oj] 9.J8Jl ut£. ut£. .!!JI
£l~~t:-l] .!f- ~At .£..!f- ~A"T'-~£. ~-f-~ A]-&~4- 0\ 7.)- "T'-~ £"1 7\ ~~ £ -f- 70J 7<\1. ~
¥-
~ £ -f-~ ~ 75 -¥- ~:£ -f-9t ~ -f-~ ~ ~ i5t~ ::@ t--¥- nJ.!f-~ -aaAJ~O] A]-&~£l~q. 1941\1 Haight17t 7-i%~£.
l1~-VJ ~:£ 3!l]~ ~ 7]:t!~:£-f- ~OH]Ai ~A ~
~g ~ifA]~~t:-l] 1936\1 Lanman13o] 7]~~qj
£. ~ =;12}91 ~-2-~4 ~% ~tJ-g At%~q. "T'-
~~oj] 0] ~ot~ ~tJ-.!f- T~o] ~-"g~~4 l:l].y
~-3i .B..~~£' ;<']li£l~JI ~oj] ~-"g~ ~~.!f- ~
~~ ~Jt!9.J ~70J~£. ;<.]li£IOi ?8 AJ.3j9.1 AJ70J%
lll4fi5}S1q.
1943\1 Haightl~ .::I9.J "T'-~ <IJ~% Jf-~ =;12}
91 ~-2-~~£. .lil.?8i5tS1~t:-l] :J. o]-&c ~~.!f- ~ 50. -¥-~ .'I:.~o] Jf-~oj]Ai ci 'i'lqJI -"gzj-~7] trJl~
o]q. 0]4- l1{!-"J -61£ 3!l]~ ~ot9.J ;<']li~ lll4f.3j 91 ~::@% 7-l%i5toj -"g-e%9.J ~7}~ 7}Ai~q· ~
;.\ij l1{!-"J -61:£ 3!l]~9.J .y~.3j 7-1;<'] ~ cio]AJ 914 .3j %.:g- AJ ~ ~£. 7,}-'r £I A] ?i JI, Jf-11.3j~.5!.. 'F.B..
~ ?;! -€:- .y~::@ ~o t9.J -"~ c.].3j AJJ:11~ .3j?8 i5} 711 -&
A]8Jl 0j: i5}~ ?;!0]q16.1718. o]?;!-€:- %~~ "5"J-"gAl] If- oj, %9.1-"J 3!l]'€loj] qj~ t-.!f- %c.];<']li, %1(!-!f:! {l 70J 7]-aa 4 :t!~!f:! {l.!f-::@ 9.J ~]li ~ "T'-'2lJ ~ 8Jl ~,
{} ~71 ~if-aa .lil.?8 ~% ~-U~q . .::I~14 oJ1917}
'V.g .y 'V.~t:-ll. 9.lif ~t-7]7t ~.B..~ {l~ ~~
-¥-::@o] 'V.~ ~Jf-0]q. ~~i5}~ if7]7} 7]:t!~£-f
~ ~8Jl 1Ill}Ai47} fL4.3j9.1 ~7] ~ 0i~71]i5tJI ~
7t if7]£ llll%~Oi .5f1 ll}~!i\ .5f1~0\ &~!8.q19,20.
0] 75Jf- 7]:t!~£-f-9.J g if ~Al] ~ qj7ij ~.3j~£.
~7]~ 7ijl1 AlZlq. ~:£ ~~~ ::-:-A] A]-&~W "T'-£
'V.JI ~0}9.J ~% AJJ:117} 7ijl1~ uJllltA] 7-l0~ ~
7]W "T'-£ 'V.q.21 ~7,}Z1 ~'2 i!ll~9.J ~Jf-oj]5O. ~
;<'}.3j ~tJ-% A]£8Jl ~.y 'V.~ a:jClllJ~~O] -'r%
£IOi ~~t:-l] a:j7]oj] ~ Livaditis ~s:.-2- ~Al]~22,
::@llJ ~-Ol~ -61:£ AJ-aa~ 2324, ~.5f1.!f- ~5::.9.J %~
.5f1 ~c.] 25, ~ 7oJ~ i5toj]Ai9.J ~7-} ~-W26, q1Cl:JI] ~
.!f- ~:£-f-~% ~~ -61:£ ~70J~27, ~£ -¥-A] ~ ~
~ AJ-¥- -61 5::. ~ i5}.!f- -61 5::. ~ 7oJ~ 28,30 ~ 0] 'V. q.
pt~, -&::@~, {l70J~, {l;;<.J.y~, 0JOJ~ ~ "5"J-"gAl]
;<.]li9.J ~::@ oj] 11
'?J
Oi -"g .e% 9.J JI] ~ .3j 91 ~ 7} 7}o]-f-Oi:;sq. Randolph %31-€:- (~A.3j ~-W% A]is~
<'>tS1% trJl Waters ton criteria oj] ut:: Ag-e%~
class A, 100%, class B, 97%, class C, 20% £. .!!
JI<'>}S1JI q1Cl:JI] ~~~ A]is~A] class C9.J -"g-e~
0] 75 % llt7.] "5"JAJ<'>tS1 g % .!!JI<'>tS1 q. Ai At~ 9.J
~Jf- class A, 93%, class B, 86%, class C, 58%
£.Ai .5f19.J .!!JI~ojj l:lj8Jl -"g-e%oj Q.j=7,} ~Oi~ g
~ "T'- 'V.~~4 .g.~ s:0}914ojj Ai 1992\1 Kim32
0] 1978\1 .!f-El 1990\,!llt:>-) 67oJ) ~ .£.o} ~1E~
tgA]9.J -"g-e% 73%ojjAi 86%.5!.. 13%9.J -"g-e%
~7t7} :t!~£l~q. ~-2- class C ~otojjAi -"g-e%
9.J ~7t7} .!!JI£lJI 'V.~t:-l] 1955\1 .!f-El 1969\1 AtO) 30%!i\ -"~-e%oj)"i 1970\1 -¥-El 1984\1 At 0] 77%9.J -"g-e%9.J 7ij {j 0) 0]-f-0i:;sq33,34. Spitz7
~ Ai~-"g ~l]~ot~ ci o]AJ ~7] ~7-} ~-w9.J -¥-.3j
%~o] o}yt:q.JI 7)~<'>PBAl 2000g 0]<,>}9.J Ai~-"g
jJl%oj-9.]
).~~%%61 %.5!.. .!2..Jl"8"m.Jl
Pohlson%
34~
2,500g 01"8"j-9.]
Al~).~jJ]%oj-9.] 250\] % 200\1 7j-
).~~~80%9.]
~.g.. ).~~%~.!2..Jl"8"j-oj Sf19.] .!2.
.Jl%4
~7-1"8"j-~q. .::1c14
).~~%9.]"5"-7j-ojls:.
~Ti>j-.Jl
~~.!jL T~' ~~.!jL ~:?,}, 7]~~s:.f- 7~~%9.]
"i"-1i-~ ~~"5"-~%%
~).~~q.01 %
~~-¥T~.g.. "i"-1i-~ %~%9.]
7j-AJ
%~~ ~~%9.] "8"j- Y-.5!.."'1 0]9-]
~).~oj] ~oj"8"j-:C ~:::::.5!..:C *~"'j-.5!..silk "'j-%Z9. 35. 36,
~~-¥- AJ~:P740, ~Sf1-¥- ~s:.9.] %~Sf1~ liJ-ej.5!.. ~~ "51~l,
711i-.3J
~1lll41%01
~q.
~~-¥- T~9-]Jt}s:.:c 4%394Zojl"'1 36%4041.43 77j-7.1
.!2..Jl~.Jl ~q. 9-
~ ~ ~-¥- T~.g.. t:J17R"i"-1i- :q:.
2~ojl"'1 4~AOlojl
~).~"8"j-oj -!-~~.5!..E.)-'<lj
~1l'<lj°l 4E.)-'dq.
-!-~ {}~.5!.. ~~ ~% ~~ol4
E.)-~
"i"-s:.
~q. 4-
~ T~.g..t:J17H
~71"i"-1i-.3J 7-1
li~ ~~.5!.. ~q
. .::1c14
t:J1-¥-~9-] ~~-¥- T~.g..ulu]"8"j-.Jl "i"-1i-:q:.
5~ojl"'i 8~"'j-°1
"'1i5~"8"j-:C-6Js:.
~OJ1i-ojl
9.]%1l
~~~q.0] 7clJf-:C
t:J1-¥-~7H"i"-1i- 9-]
~~'il:l°l:AlA.:!
.5!.. ~~q.:Al:A}%9-] 7cH- 160\1
(17%)9.]
~~-¥- T~ol ~~:Cr~l 10\1~ ~191~150\]:C
u1u]~ T~.5!.."'i Ai~.5!.. ~~q. 4~0l}.J
9-l%{}
~AJ1i-°1 ~~~t'i ~~-¥- 7{;l~~8%44oj1
"'1 49%43.45 77j-7.1
.!2..Jl~<>1 ~q.:A17.}%9-] 7cH- 37
0\19-]
~~-¥- 7{;l~01 ~~~4 4~°VJ9-] %{}
~AJ1i-°1
~~~t'i 7cH-~%{}
~AJ1i-9.] ~~"5"-~.5!.."'}DJ~ 20\1~ ~1%-¥-E1
"i"-1i-%
"'1i5~~10\1
~ ~1~"8"}1i':! 70\1.5!.."'1 21 % 9-]
~ ~-¥-7{;l.:3}% .!i!. oj Sf19-] .!i!.
.Jl~4 tl1;::~ ~4~ .!i!.~q.
ojc17}7.1
{}i5~ ~~01
~~.!f'- 7{;l~ojl-¥l:oj"8"}:C
?}~.5!.. .!i!..Jl~:Cr~loj
71oj1~ *~",}.5!..
silk"'j-%7, 01%
~~4647, ~~-¥AJ~48, ~~.!f'- T~ ~
Sf1-6Js:.
~_ff-45.497} .¥.-y~q. 71-¥l:-6J s:. f- 7H
~9.] Jt}s:.:c 5 % ojl "'i 11 % 77}7.1
.!i!..Jl~~q3Z5051. Al:Aj-~9.] 7cl4-
30\1 (3.1 % )oj1"'1
71~-6Js:.if- 7H~%
.!i!.oj Sf19.] .!i!..Jl% .!i!.q ';>t.g.. 7H
~~% .!i!.~q. 71~-6Js:.if- 7H~~ ~~-¥- *~{}9.]
T~.5!..
oJ
~.;;-::::: {}
cg ~ ~oJ
f:~l"'a.Q..5!..71
~~s:.
if-
AJ ~1.!f'-.!fl
.!f'-~oj1 9-] %1l
~).~"8"}:C
?}.Q..5!..).g z.t
~q41. 1962\! Waters ton %5 Z.g.. "i"-1i-{i
~A}~9.]%~ }.JEl1~ 0\1~~ ~ ~*"8"j-oj tl1.li!."8"}~ ~117-11 ~
s:. 'iJ -o}oj Sf1"'B
~ ~~.5!..:Ai
~).g ~11%, 1111 '€l,
% tfr71
~
%%
.~"y"8"}~q. 0lci~ ~~~ l:I}'l~.5!.."8"}oj'\'i'.g.. :::::01-.914
9.]",}%~Waterston class B, C
~9-] .li!.1:1 "i"-1i-%
~7]"8"}~q. ~7Hs:.Waterston
~*~01 ~ej
1':°1.Jl
~~4 ~~ ~IA%.g..019-] % iL}.aoj1
9.]~% ~171"8"}.Jl'V,q185354. U:}C+"'i
~7H:C~i
g
~171~~%ulloj1 tl1%1l Waterston criteria :c
:~lA9.]
0\1
~~7-1li
~1:1 oj1 'V, <>1 %
iL}.a°
1 1f:l.<>1 7.]
.Jl 'V,
~ ,,}).~1° 1 q. <>1 tt1 Ai 7.j-%.g.. <>1 u1
~ ~* ~s:.
7-l-¥-"8"}.Jl "i"-1i-.3J 7-1li9.] 7.1
~~.5!.."'i ~6}9-].).gej.3J
~El1 ~1:1 ~ ~RElj~q18. tfrrrl 9:.
q-e Al7.}%.g.. {i
.!8-.3J~
Waterston cirteria 9.]
t;!!~% "'1s:.~t:P·755.A1:A}%9.]
7cl4-Waterston criteria ojl
U:}C+ ~01-%%
~*%1l .!i!.~.Q.4 {l).~oj- %~7.1- ~lli, D}~,"i"- 1i-
tlJ~%9.]
7~{}~.5!.."i"-1i- "'171:C 01
~*~ojl ~ 7-11~01 7R~~~~q. {l)'~01- %~A ~ej, *~.3J~.:g.. ~%71.
"i"-1i-
tlJ~9-] ~{i4-ylJjl {l).g01-
01-~9-]
~.!i!., %tfr 71~9.] ~71 ~~ ~ ~lli, ~~-¥~~"5"-9.] ~z.t.3J ~7,:!, ~~-¥- 7{;l~9.] ~AJ1i- ~
Sf1 -6J s:.
~*9-] .3J -s-.3J
~7-1li.5!.. {}
~}.a-6J s:. llll $:Jl
~oj-9-1
).g~%ol ~7j-~~.Jl °1~1:::::;:;:'9-1
O\l~~ ~l 91~ t:J1.!f'-~9.]-6Js:. 1ll1$:Jl
~01-7} ).g~"8"}:C"'1t:J17}
~'M?}°1 71t:J1~q.
A1 7.1-%
~960\19-1 {}
~ }.a -6Js:. llll $:Jl
~ ~~"8"j-oj
qg9.]
~4~ ~~q.1) ';:f1-:jtll:C 1.1:1.5!..
l:Il~"8"mq.2)
~).~"'1llan-
7.11%~2.8kg
~.Jl2.5kg ul1il-9-]
Ai~).~
jJ1%0j-7}
32.3%~ ~}7.mq.3)
9-"5"-}.J~q'<lj
~tl]4q, "i"-%"')
~% ~~,78
~~ %o]~q.
4) Gross
~*~oj] 9-1~ %1l.!f'-~.3j *~.g..Type C 7} 7j-AJ fi.g.. Jt}s:..5!..
-¥l:~~~q(82.3%). 5)
%tfr {}~}.a 7]~0135%ojl"'1
~~~~.Jl01 %
{l
AJ
71~017}AJ fi.g.. Jt}s:..5!..
~~~~q(60%)
6) "i"-1i-
~Type
A,C9.]
7cl4- ~ ~}.3j ~ ~%"'1
i5~"8"}~.Jl ~~}.3j ~~ol ~7j-~~ ~{}?oj ~~ ~
oj-ojl"'l
Q;jSf1~{}'iJ1i-°l
"'li5~~~q. Type ECH-type)9-]
7cl4- ~s:.71~if- AJ~l1i-°l.Type
F9.]
7cl4- ~s:.7{;l~.!f'-Sf1 AJ~l ~ ~~ ~~1i-°l- :t.o}9-1>4 : ;<J]1 -tl ;<J] 2 ~ 1995'-;1 -
:3j-, 7]:.tl: ~s:.-'f- 7-H~ %o]~q.
8) ).~-e-%.g. 86%~jl Waterston Criteria oj] rr:j-
~ A~ -e-%.g. Class A, 93 %, Class B, 86 %, Class, 58%~q.
9) ~~ ~;..} ~:ll} 93%91 ~O}7} 7,27J~jl 7%91
~O}7} ?[.g. ~%7] ~'i'l.9...£ ~H:!~ ~ ~o] ~
REFERENCES
1. Haight C, Towsley HA: Congenital atresia of the esophagus with tracheoesophageal fis- tula; extrpleural ligation of fistula and end- to-end anastomosis of esophageal segments.
Surg Gynecol Obstet 76: 672-688, 1943 2. Beasley SW, Auldist AW, Myers NA: Cur-
rent surgical management of oesophageal atresia and/or tracheoesophageal fistula.
Aust N Z J Surg 59:707-712,1989
3. Louhimo I, Lindahl H: Esophageal atresia:
primary results of 500 consecutively treated patients. J Pediatr Surg 18:217-219, 1983 4_ Rivosecchi M, Bagolan P, Matarazzo E:
Esophageal atresia; critial review of 10 years experience_ Pediatr Surg Int 4: 95-100 1989
5. Abrahamson J, Shandling B: Esophageal atresia in the underweight baby; a chal- lenge. J Pediatr Surg 7:608-613,1972 6. Rickham PP: Infants with esophageal atre-
sia weighing under three pounds_ J Pediatr Surg 16: 595-598, 1981
7. Spitz L, Kiely E, Brereton RJ: Esophageal atresia; five-year experence with 148 cases.
J Pediatr Surg 22:103-108,1987
8. Bishop PJ, Klein MD, Philipport AI, Hixion DS, Ertzler JH: Traspleural repair of esoph- ageal atresia without a primary gastrosto- my; 240 patients treated between 1951 and
1983. J Pediatr Surg 20: 823-828, 1985 9. Chittmittrapap S, Spitz L, Kiely EM: Oe-
sophageal atresia and associated anomalies.
Arch Dis Child 64: 364, 1989
10. Durston W: A narrative of monstrous birth in plymouth October 22,1670; together with the anatomical observation taken thereupon by William Durston, Doctor in physick, and communication to Dr. Tim Clerk. Philos Trans T Soc 5:2096,1670
11. Gibson T: The anatomy of humane bodies epitomized, 6th ed, London, Awnsha &
Churchill, 1703, cited from Randolph JG:
Esophageal atresia and congenital stenosis in welch KJ, Raudolph JG, Ravitch MM et al (eds): Pediatric surgery ( ed 4), chapter 68, Chicago, IL, Yearbook, Medical publishers INC, 1986, Pp682-697
12. Vogt EC: Congintal esophageal atresia. Am J Roentgenol 22: 463 1929 I 13. Lanman TH: Congenital atresia of the
esophagus. A study of 32 cases. Arch Surg 41: 1060-1083, 1940.
14. Leven NL: Congenital atresia of the esopha- gus with tracheoesophageal fistula; Report of successful extrapeuralligation of fistulous communication and cervical esophagostomy.
J Thorac Surg 10:648-657,1941
15. Ladd WE : The surgical treatment of esoph- ageal atresia and tracheoesophageal fistulas N Eng J Med 230: 625-637, 1944
16. Grosfeld JL, Ballantine RVN: Esophageal atresia and tracheoesophageal fistula;effect of delayed thoracotomy on survival. Surgery 84:394, 1978
17. Randolph JG, Altman RP, Anderson KD:
Selective surgical management based upon clinical status in infants with esophageal atresia. J Thorac Cardiovasc Surg 74: 335- 342, 1977
18. Randolph JG, Neuman KD, Anderson KD:
Current results in repair of esophageal atre- sia with tracheoesophageal fistula usmg physiologic status as a guide to therapy.
Ann Surg 209:526-531,1989
19. Jones TB, Kirchner SG, Lee FA: Stomach rupture associated with esophageal atresia, tracheoesophageal fistula and ventilatory assistance. Am J Radiol 134: 675, 1980 20. Malone PS, Kiely EM, Brain AJ: Tracheo-
esophageal fistula and preoperative mechani- cal ventilation. Aust N Z J Surg 60: 525, 1990, Cited from Spitz L, Liely E, Brereton RJ, Drake D: Management of esophageal atresia. World J Surg 17:296-300, 1993 21. Holmes SJK, Kiely EM, Spitz L: Tracheo-
esophageal fistula and the respiratory dis- tress syndrome. Pediatr Surg Int 2: 16, 1987 22. Livaditis A: Esophageal atresia; a method of
over bridging large segmental gaps. Z Kinderchir 13: 298-306, 1973
23. Devenport M, Bianchi A: Early expenence with oesophageal flap oesophagoplasty for repair of oesophageal atresia. Pediatr Surg Int 5: 332-335, 1990
24. Gough MH: Esophageal atresia; Use of an anterior flap in the difficult anstomosis. J Pediatr Surg 15:310,1980
25. Beasley SW: Oesophageal atresia without fistula. in Beasley SW, Myers NA, Auldist AwCeds): OesophagecaJ atresia, London, Chapman & Hall, 1991, Pp137-159
26. Mackinley G A, Burtles R: Oesophageal atre- sia, paralysis and ventilation in management of wide gap. Pediatr Surg Int 2: 10, 1987 27. Kimura K, Soper RT: Multistaged extratho-
racic esophageal elongation for long gap esophageal atresia. J Pediatr Surg 29: 566- 568, 1994
28. 0lqj12j: ~Z!Z1 ~~ ~5:. il11~-6'-~ ~~}~ ~ 5:. ~~. ~o}.21:ilj- ~11.-t! ~11~ : 53-58, 1995 29. Howard R, Myers NA: Esophageal atresia;
A techlllque for elongating the upper pouch.
Surgery 58: 725, 1965
30. Mahour GH, Wolley MM, Gwinn JL: Elon- gation of the upper pouch and delayed anas- tomotic reconstruction in esophageal atresia.
J Pediatr Surg 9:373, 197~
31. Kim WK: Esophageal atresiaCT - E fistu- la); an index for neonatal surgery. Early Human Develop 29: 369-373, 1992
32. Manning PB, Morgan RA, Coran AG: Fifty years experience with esophageal atresia and tracheoesophageal fistula. Ann Surg 204: 446-453, 1986
33. Wise WE, Caniano DA, Harmel RP: Tra- cheoesophageal anomalies in Waterston C neonates; a 30-year perspective. J Ped Surg 22: 526-529, 1987
34. Pohlson EC, Schaller RT, Tapper D: Im- proved survival with primary anstomosis in the low birth weight neonate with esophage- al atresia and tracheoesophageal fistula. J Pediatr Surg 23:418-421,1988
35. Cudmore RE: Oesophageal atresia and tracheo-oesophageal fistula, in Rickham PP, Lister J, Irving IMCeds): Neonatal Surgery Ced 2), Butterworths, London, 1978, Pp189- 208, cited from Engum SA, Grosfeld JL, West KW, Rescorla FJ, Tree Scherer III LR : Analysis of morbidity ana mortality in 227 cases of esophageal atresia and/or tra- cheoesophageal fistula over two decades.
Arch Surg 130: 502-506, 1995.
36. Randolph JG : Esophageal atresia and con- genital stenosis, in Welch KJ, Randolph JG, Ravitch MM Ceds): Pediatric SurgeryCed 4), Chapter 68, St Louis, Mo, Mosby-year Book, 1986, Pp682-697
37. Hagberg S, Rubenson A, Sillen V, Werkmaster K: Management of long-gap esophagus; expenence with end-to-end anstomosis under maximal tension. Prog
- 147-
Pediatr Surg 19:88-92,1986
38. Howell CG, Davis JB Jr, Parrish RA: Pri- mary repair of esophageal atresia; how long a gap? J Pediatr Surg 22:42-43,1987 39. O'Neill JA, Holcomb GW, Neblett WW: Re-
cent experience with esophageal atresia.
AnnSurg 195:739-745, 1982
40. Sillen U, Hagberg S, Rubenson A, et al:
Management of esophageal atresia; Review of 16 years' experience. J Pediatr Surg 23:
805-809, 1988
41. Holder TM, Ashcraft KW: Complications of pediatric surgery; prevention and manageh- ment in Welch DJ(ed): Esophagus, Philadel- phia, Pa, WB Saunders Co: 1982, Pp 199- 207
42. Touloukian RJ: Long-term results follow- ing repair of esophageal atresia by end - to
-end anastomosis and ligation of tracheo- esophageal fistula. J Pediatr Surg 16: 983- 988, 1981
43. Leendertes VK, Tibboel D Hazebrock FW J:
Postoperative morbidity in patients with esophageal atresia. Pediatr Surg Int 2: 2-5, 1987
44. Holder TM, Ashcraft KW Sharp RJ: Care of infants with esophageal atresia, tracheo- esophageal fistula and associated anomalies.
J Thorac Cardiovasc Surg 94: 828-835, 1987 45. Holder TM: Esophageal atresia and tracheo-
esophageal fistula, in Ashcraft KW, Holder TM(eds): Pediatric Esophageal surgery, philadelphia, Pa, Grure station: 1987, Pp 29 -52
46. Hicks LM, Manfield PB: Esophageal atresia and tracheoesophageal fistula: review of thirteen years' experience. J Thorac Cardiov- asc Surg 81: 358-363, 1981
47. Holder TM, Cloud DT, Lewis JE Jr, Pilling GP IV: Esophageal atresia and tracheo- esophageal fistula: a survey of its members
by the surgical section of the American Academy of Pediatrics. Pediatrics 34: 542- 549, 1964
48. Jolly SG, Johnson DG, Roberts CC: Patterns of gastroesophageal reflux in children follow- ing repair distal tracheoesophageal fistula. J Pediatr Surg 15: 857 -862, 1980
49. Aprigliano F: Esophageal stenosis in chil- dren. Ann OtoI89:391-395, 1980
50. Ein SH, Stringer DA, Stephen CA, Shand- ling B: Recurrent tracheoesophageal fistulas seventeen-year review. J Pediatr Surg 18:
436-441, 1983
51. Kafrouni G, Baick CH, Wooley MM: Recur- rent tracheoesophageal fistula: a diagnostic problem Surgery 68: 889-894, 1970
52. Waterston DJ, Bonham-Carter RE, Aber- deen E: Esophageal atresia; tracheoesopha- geal fistula;a study of survival in 218 in- fants. Lancet 1 :819-822,1962
53. Ein SH, Shand ling B, Wesson D: Esophageal atresia with distal tracheoesphageal fistua;
associated anomalies and prognosis in 1980s.
J Pediatr Surg 24:1055-1059,1989
54. Poenaru D, Laberge JM, Neilson IR: A new prognostic classification for esophageal atre- sia. Surgery 113:426-432, 1993
55. Shaul DB, Schwartz MZ, Marr CC: Primary repair without routine gastrostomy as the treatment of choice for neonates with esoph- ageal atresia and tracheoesphag-
eal fistula. Arch Surg 124: 1188-1191, 1989 56. Gross RI;:: Surgery of infancy and child- hood. Philadelphia, W. B. Saunders Co, 1953, cited from Randolph JG : Esophageal atresia and congenital stenosis, in Welch KJ, Ran- dolph JG, Ravitch MM, et al (eds) : Pediat- ric Surgery(ed 4), Chapter 68. Chicago, IL, Yearbook, Medical Publishers INC, 1986, Pp682-697
