Současné výsledky léčby atrézie jícnu

Esophageal Atresia – Outcome in Recent Era

Background.
The aim of the study was to analyze mortality, incidence of complications and influence of variousprognostic factors on the outcome of patients with esophageal atresia.A retrospective analysis of the records of 109 consecutive cases of esophageal atresia and/or tracheoesophagealfistula operated in 1992–2001 was undertaken. Primary anastomosis was achieved in 68 (62,4 %) patients, in 7(6,4%) procedures aimed at esophageal substitution in future were performed and in 34 (31,2%) delayed anastomosiswas primarily planned.Methods and Results. Major associated anomalies were found in 55 (50,4 %), cardiac anomalies in 19 (17,4 %),and more than one associates anomaly in 16 (14,7 %) patients.Themost frequent surgical complication was anastomotic leak in 11,9%, septic complications were themost frequentand occurred in 66 (60,5 %) patients. Gastroesophageal refluxwa s diagnosed in 30,3 % and treated surgically in14,7 % of infants. The overall mortality was 20,2% (22 patients). The most frequent cause of death was sepsis and/orpneumonia. Long gap esophageal atresia was not found to be a significant factor in mortality. Factors significantlyincreasing mortality were birth weight below 2000g (OR 3,94), cardiac anomalies (OR 3,95), and mechanicalventilation before the operation (OR 2,97).Conclusions. Analysis of the outcome suggests that improved strategy in treating infants with multiple anomaliesand more frequent attempts at primary anastomosis even in children in sub optimal general condition at diagnosiscould decrease mortality.

Key words:
esophageal atresia, congenital anomalies, gastroesophageal reflux, mortality.