摘要
目的探讨先天性长段缺失型食管闭锁诊治策略的选择及疗效。方法回顾性分析2010年1月至2019年12月间收治的25例采用分期手术治疗的先天性长段缺失型食管闭锁患儿的临床资料。其中,男13例,女12例;出生体重(2.61±0.60)kg,范围在1.50~3.48 kg。25例患儿中,Ⅰ型食管闭锁13例食管缺失长度为(6.42±0.85)个椎体,范围在4~7个椎体;Ⅱ型5例食管缺失长度为(5.80±1.48)个椎体,范围在4~8个椎体;Ⅲa型7例食管缺失长度为(3.28±0.48)个椎体,范围在3~4个椎体。合并畸形11例。Ⅰ型患儿行自然延长完成食管吻合手术3例,自然延长联合食管内张力延长完成手术10例。Ⅱ型患儿行Kimure技术联合胃管替代完成手术2例,Kimure技术联合食管内张力延长完成手术1例,自然延长完成手术2例。Ⅲa型病例中1例外牵引延长食管完成手术,4例自然延长完成手术,2例自然延长联合食管内张力延长完成手术。结果25例患儿均顺利完成食管吻合,除2例Ⅱ型食管闭锁患儿采用胃管替代,余者均行胸腔镜下食管端端吻合术。本组除1例Ⅱ型患儿于术后6 d并发严重肺部感染死亡外,余者均获随访4个月至8年。1例Ⅰ型食管闭锁患儿术前行食管内张力延长透视检查时探条至下端食管穿孔。术后出现吻合口漏4例;食管狭窄22例,均予以胃镜下沙氏探条或球囊扩张治愈,无食管气管瘘复发;不同程度胃食管反流12例。目前所有患儿仍在随访中。结论对于长段缺失型食管闭锁,需依据不同患儿选择个体化治疗方案,通过各种食管延长技术、延期、分期手术能使绝大部分患儿依靠自身食管延长完成食管吻合,其具体疗效尚需进一步随访。
Objective To explore the treatment options and efficacies of congenital long-gap esophageal atresia.Methods Retrospective analysis was performed for clinical data of 25 cases of congenital long-gap esophageal atresia undergoing staged operations from January 2010 to December 2019.There were 13 boys and 12 girls with a mean birth weight of(1.50-3.48)(2.61±0.60)kilogram.Type I(n=13)(lacking esophageal length 4-7 of vertebral body,an average of 6.42±0.85 vertebral body),typeⅡ(n=5)(lacking esophageal length of 4-8 vertebral body,an average of 5.80±1.48 vertebral body)and typeⅢa(n=7)(lacking esophageal length of 3-4 vertebral body,an average of 3.28±0.48 vertebral body).There were 11 cases of combined malformations.Among type I cases,the procedures included natural prolongation(n=3)and natural prolongation plus intraesophageal tension prolongation(n=10);In type II cases,Kimure technique plus gastric tube replacement(n=2),Kimure technique plus esophageal tension extension(n=1)and natural extension(n=2);In typeⅢa cases,extending esophagus by external traction(n=1),natural extension(n=4)and natural extension plus an extension of intraesophageal tension(n=2).Results All 25 cases successfully completed esophageal anastomosis.Two cases of type II were replaced by gastric tube while the remainders underwent thoracoscopic esophageal end-to-end anastomosis.One child of type II died of severe pulmonary infection at 6 days post-operation.The remainders were followed up for 4 months to 8 years.For 1 case of type I esophageal atresia,intraesophageal tension extension fluoroscopy was performed for detecting the perforation of lower esophagus.There were 4 cases of anastomotic leakage.And 22 cases of anastomotic stenosis were cured by probe or balloon dilation.There was no recurrence of esophagotracheal fistula.Twelve cases developed gastroesophageal reflux of verying degrees.All children were still followed up.Conclusions Children with long-gap esophageal atresia should be managed individually.Esophageal anastomosis may be completed by self-lengthening of esophagus through a variety of esophageal extension techniques,postponement and staged operations.However,the ultimate efficacy still requires further follow-ups.
作者
樊纬
黄金狮
陈快
陶俊峰
刘智文
徐美汉
曾祥勇
万颢
杨治
陶强
Fan Wei;Huang Jinshi;Chen Kuai;Tao Junfeng;Liu Zhiwen;Xu Meihan;Zeng Xiangyong;Wan Hao;Yang Zhi;Tao Qiang(Department of Neonatal Surgery,Jiangxi Children's Hospital,Nanchang 330006,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2020年第6期484-488,共5页
Chinese Journal of Pediatric Surgery
基金
江西省卫计委科技计划项目(20171130)。
关键词
食管闭锁
治疗
经验
Esophageal atresia
Treatment
Experience
