END-TO-END VERSUS END-TO-SIDE ANASTOMOSIS IN THE TREATMENT OF ESOPHAGEAL ATRESIA OR TRACHEO-ESOPHAGEAL FISTULA

Background: Dehiscence of esophageal anastomosis is frequent and there are still controversies which type of anastomosis is preferred to diminish its incidence . Aim: To compare end-to-end anastomosis versus end-to-side anastomosis in terms of anastomotic leakage, esophageal stricture and gastroesophageal reflux symptom. Methods: This study was carried out for two year starting from 2012. End-to-side and end-to-side anastomosis were compared in terms of anastomotic leakage, esophageal stricture, gastroesophageal reflux symptom, length of surgery and pack cell infusion. Results: Respectively to end-to-end and end-to-side anastomosis, duration of surgery was 127.63±13.393 minutes and 130.29±10.727 minutes (p=0.353); esophageal stricture was noted in two (5.9%) and eight (21.1%) cases (p=0.09); gastroesophageal reflux disease was detected in six (15.8%) and three (8.8%) cases (p=0.485); anastomotic leakage was found in five (13.2%) and one (2.9%) cases (p=0.203); duration of neonatal intensive care unit admission was significantly shorter in end-to-end (11.05±2.438 day) compared to end-to-side anastomosis (13.88±2.306 day) (p<0.0001). Conclusion: There were no significant differences between end-to-end and end-to-side anastomosis except for length of neonatal intensive care unit admission which was significantly shorter in end-to-end anastomosis group.

背景：食管吻合口裂开（dehiscence of esophageal anastomosis）较为常见，目前对于何种吻合方式可降低其发生率仍存在争议。目的：对比端端吻合（end-to-end anastomosis）与端侧吻合（end-to-side anastomosis）在吻合口漏、食管狭窄及胃食管反流症状方面的差异。方法：本研究于2012年启动，为期两年。研究对端端吻合与端侧吻合的吻合口漏发生率、食管狭窄情况、胃食管反流症状、手术时长及红细胞输注（pack cell infusion）量进行对比分析。结果：针对端端吻合与端侧吻合两组，手术时长分别为127.63±13.393分钟与130.29±10.727分钟（p=0.353）；食管狭窄病例数分别为2例（5.9%）与8例（21.1%）（p=0.09）；胃食管反流病检出例数分别为6例（15.8%）与3例（8.8%）（p=0.485）；吻合口漏检出例数分别为5例（13.2%）与1例（2.9%）（p=0.203）；端端吻合组新生儿重症监护病房（neonatal intensive care unit, NICU）住院时长为11.05±2.438天，显著短于端侧吻合组的13.88±2.306天（p<0.0001）。结论：端端吻合与端侧吻合在各项观察指标中均无显著差异，仅端端吻合组的新生儿重症监护病房住院时长显著更短。