儿童微创食管替代术：系统评价与Meta分析
Minimally Invasive Esophageal Replacement in Children: A Systematic Review and Meta-analysis.
文献信息
| PMID | 42716275 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ahmed Maher |
| 作者单位 | Department of Pediatric Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: ahmedmaher_31@med.aun.edu.eg. |
| 期刊 | Journal of pediatric surgery |
| SCI 分区 | Q2 |
| IF | 2.3 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景/目的： 儿童食管替代术传统上通过开胸开腹入路进行。微创手术（MIS）在部分儿科中心的应用日益增多，但相关经验仍分散于各小样本系列中。我们汇总现有证据，以量化儿童MIS食管替代术的安全性和有效性。
方法： 本综述遵循PRISMA 2020规范，检索了PubMed、Scopus和Web of Science自建库至2025年8月31日的文献。两名评价者独立筛选记录、提取数据，并使用非随机研究方法学指数（MINORS）评估质量。采用Comprehensive Meta-Analysis v3.3软件在随机效应模型下计算合并率和均值。
结果： 共纳入12项研究（159例儿童，2007-2024年）。手术时平均年龄为25.2个月；主要适应证为长段缺失型食管闭锁（65.9%）和腐蚀性损伤（33.5%）；88.9%使用了全胃代食管。合并手术时间为283.5分钟。中转开腹发生率为9.4%；吻合口漏为16.1%（集中于胃管代食管）；狭窄为31.3%；复发性喉返神经麻痹为9.3%。报告了1例30天手术相关死亡（0.6%；95% CI 0.02-3.45%）。在平均41.7个月的随访中，75.1%实现了完全或主要以口进食。
结论： 在有经验的中心，儿童腹腔镜食管替代术似乎可行，30天死亡率低且中转开腹少见；吻合口狭窄是主要并发症。有限且多为回顾性的证据提示需谨慎解读，并应开展前瞻性多中心研究。
证据等级： IV（回顾性和观察性研究的系统评价）。
英文摘要
BACKGROUND/PURPOSE: Esophageal replacement in children is traditionally performed through open thoraco-abdominal approaches. Minimally invasive surgery (MIS) is increasingly used in selected pediatric centers, but experience remains fragmented across small series. We pooled the available evidence to quantify the safety and efficacy of pediatric MIS esophageal replacement.
METHODS: This PRISMA 2020-compliant review searched PubMed, Scopus and Web of Science from inception to 31 August 2025. Two reviewers independently screened records, extracted data, and assessed quality using the Methodological Index for Non-Randomized Studies (MINORS). Pooled rates and means were calculated under random-effects models in Comprehensive Meta-Analysis v3.3.
RESULTS: Twelve studies (159 children, 2007-2024) were included. Mean age at surgery was 25.2 months; main indications were long-gap esophageal atresia (65.9%) and caustic injury (33.5%); a whole-stomach conduit was used in 88.9%. Pooled operative time was 283.5 minutes. Conversion to open occurred in 9.4%; anastomotic leak in 16.1% (concentrated in gastric-tube conduits); stricture in 31.3%; and recurrent-laryngeal-nerve palsy in 9.3%. One 30-day procedure-related death was reported (0.6%; 95% CI 0.02-3.45%). At a mean follow-up of 41.7 months, 75.1% achieved full or predominantly oral feeds.
CONCLUSIONS: In experienced centers, pediatric laparoscopic esophageal replacement appears feasible, with low 30-day mortality and infrequent conversion; anastomotic stricture is the main morbidity. The limited, mostly retrospective evidence warrants cautious interpretation and prospective multicenter study.
LEVEL OF EVIDENCE: IV (systematic review of retrospective and observational studies).