摘要
目的探讨胸腔镜手术治疗低出生体质量儿Ⅲ型食管闭锁的临床经验,总结其可行性及临床效果。方法回顾性分析2018年1月至2023年2月在首都儿科研究所附属儿童医院行胸腔镜手术的25例低出生体质量Ⅲ型食管闭锁患儿的临床资料,其中男性14例,女性11例;Ⅲa型18例,Ⅲb型7例。出生体质量1350~2460 g,平均(2082±331)g,其中极低出生体质量儿2例,分别为1350 g、1440 g。足月儿8例,早产儿17例,出生胎龄为30+3~38+6周。手术时年龄最小者为出生后4 h,最大者为出生后20 d。5例患儿术前需要有创呼吸机支持。术前均行食管造影确诊,在胸腔镜下完成食管气管瘘结扎术+食管端端吻合术。结果21例患儿在胸腔镜下完成手术,4例中转开胸手术。手术时间143~300 min,平均(189±40)min。术后呼吸机使用时间18~841 h,中位数168 h。住院时间8~83 d,中位数30 d。术后吻合口漏2例,予保守治疗1~3周后自愈。食管气管瘘复发1例,予保守治疗后自愈。术后吻合口狭窄12例,予定期胃镜下食管球囊扩张,症状明显缓解。1例患儿合并多囊肾伴肾发育不全,术后7 d出现重症感染、肾功能衰竭,家属放弃治疗后死亡。余24例治愈出院。24例术后随访1~60个月,中位数28个月。2例术后4~5个月出现胃食管反流,行腹腔镜胃底折叠术。结论胸腔镜手术治疗低出生体质量儿Ⅲ型食管闭锁总体安全有效,术后并发症未见增多,随着手术技术的提高、围术期管理的改善,胸腔镜治疗低出生体质量儿食管闭锁可逐步开展。
Objective To explore the clinical experience of thoracoscopic surgery in the treatment of typeⅢesophageal atresia in low birth weight infants,and to summarize its feasibility and clinical effect.Method Retrospective analysis of the clinical data of 25 children with low birth weight typeⅢesophageal atresia who underwent thoracoscopic surgery in Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2018 to February 2023 were performed,including 14 males,11 females,18 cases of typeⅢa and 7 cases of typeⅢb.Their birth weights ranged from 1350-2460 g with a mean of(2082±331)g.There were 2 cases with very low birth weight,1350 g and 1440 g.There were 8 full-term infants and 17 preterm infants with a birth gestational week of 30+3-+638 weeks.At the time of operation,the youngest patient was 4 h after birth and the largest patient was 20 d after birth.Five cases required preoperative invasive ventilator support.Preoperative esophagography was performed to confirm the diagnosis,and the esophagotracheal fistula ligation+esophageal end to end anastomosis was done by thoracoscopy.Result 21 cases were completed the operation under thoracoscopy,and 4 cases were operated in open-heart surgery.The operative time was 143-300 min,with an average of(189±40)min.Postoperative ventilator use time was 18-841 h,with a median of 168 h.Hospitalization time was 8-83 d,with a median of 30 d.Two cases of postoperative anastomotic leak were treated conservatively for 1-3 weeks and then healed spontaneously.One case of recurrent esophagotracheal fistula was treated conservatively and healed spontaneously.In 12 cases of postoperative anastomotic stenosis,regular gastroscopic dilatation of the esophageal balloon was performed,and the symptoms were significantly relieved.One case with polycystic kidney and renal insufficiency developed severe infection and renal failure 7 d after surgery,and died after the family gave up treatment.The remaining 24 cases were cured and discharged from the hospital.24 cases were followed up for 1-60 months after surgery,with a median of 28 months.Two cases developed gastroesophageal reflux symptoms 4-5 months after surgery and underwent laparoscopic fundoplication.Conclusion Thoracoscopic surgery for low birth weight infants of typeⅢesophageal atresia is generally safe and effective,and no increase in postoperative complications is observed.With the improvement of surgical technique and perioperative management,thoracoscopic treatment of esophageal atresia in low birth weight infants can be carried out gradually.
作者
魏延栋
王莹
马立霜
冯翠竹
刘雪来
张艳霞
刘超
吴涛
李景娜
冯众
Wei Yandong;Wang Ying;Ma Lishuang;Feng Cuizhu;Liu Xuelai;Zhang Yanxia;Liu Chao;Wu Tao;Li Jingna;Feng Zhong(Department of Neonatal Surgery,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China)
出处
《发育医学电子杂志》
2023年第4期277-281,共5页
Journal of Developmental Medicine (Electronic Version)
基金
北京市自然科学基金青年项目(7224321)。
关键词
食管闭锁
胸腔镜
低出生体质量儿
食管造影
食管气管瘘
Esophageal atresia
Thoracoscopy
Low birth weight infants
Esophagography
Esophagotrachealfistula
