摘要
目的总结Ⅲa型先天性食管闭锁分期食管重建手术治疗经验。方法回顾性分析2020年7月至2022年2月就诊于首都医科大学附属北京儿童医院,未能完成一期食管吻合的Ⅲa型先天性食管闭锁3例患儿的临床资料。3例患儿均为男性,末次胸腔镜下行食管端端吻合时年龄分别为1岁7个月、3个月10 d、7个月16 d,观察患儿术后情况并随访。结果3例患儿均在胸腔镜下完成食管重建术,未行食管替代术。术后均转入儿科重症监护治疗病房呼吸机支持治疗7~10 d。1例患儿术后出现吻合口漏,经空肠喂养管肠内营养,放置食管上段吸引管吸引口水,保守治疗后,吻合口自愈。3例患儿术后随访3~12个月,均存在食管狭窄,定期在内镜下球囊扩张治疗中。目前患儿均全量经口喂养,生长发育良好,体重增长满意。结论Ⅲa型食管闭锁分期手术难度大,一期术后食管内张力延长术是促进食管生长、增加食管弹性的有效手段。二期术中吲哚菁绿荧光成像可辅助瘘管定位,确保分离、结扎瘘管确切,避免周围组织损伤,有效改善预后。
Objective To summarize the institutional experiences of esophageal reconstruction surgery for typeⅢa congenital esophageal atresia(CEA).Methods From July 2020 to February 2022,retrospective analysis was performed for the relevant clinical data of 3 boys with type IIIa CEA undergoing a failed primary esophageal anastomosis at other hospitals.The age was 19 months,3 months plus 10 days and 7 months plus 16 days at the time of final thoracoscopic esophageal anastomosis.Follow-ups were conducted.Results Esophageal reconstruction was completed thoracoscopically without esophageal substitution.All of them stayed in pediatric intensive care unit(ICU)for ventilator supports for 7-10 days.One case of postoperative anastomotic leakage healed spontaneously after conservative measures with enteral nutrition via a jejunal feeding tube and inserting a supraesophageal suction tube for collecting saliva.Three cases were followed up for(3-12)months after operation.Esophageal stenosis was periodically managed with endoscopic balloon dilatation.All of them were fully orally fed with decent growth and satisfactory weight gain.Conclusions Type IIIa CEA is difficult to operate in stages.Endotension esophageal lengthening after phase I surgery is effective for promoting esophageal growth and enhancing esophageal elasticity.Intraoperative indocyanine green fluorescent imaging in a second stage may assist in fistula localization,ensuring accurate separation and ligation of fistula,and avoinding damaging the surrounding tissues and effectively improve the prognosis.
作者
赵勇
黄金狮
李爽爽
廖俊敏
华凯云
谷一超
张雅楠
赵家伟
唐彩涵
Zhao Yong;Huang Jinshi;Li Shuangshuang;Liao Junmin;Hua Kaiyun;Gu Yichao;Zhang Yanan;Zhao Jiawei;Tang Caihan(Department of Neonatal Surgery,Beijing Children's Hospital,Capital Medical University,National Center of Children's Health,Beijing 100045,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2024年第4期304-308,共5页
Chinese Journal of Pediatric Surgery
基金
北京市科学技术委员会资助项目(Z211100002921062)
江西省卫生健康委科技计划(202310065)。
关键词
食管闭锁
食管扩张
食管造影
Esophageal atresia
Esophagectasis
Esophagography
