摘要
目的本文介绍4例I型食管闭锁延期食管吻合的治疗经验，供临床参考。方法4例均为女性，出生体重分别为2．75kg、2．30kg、2．45kg、2．50kg，无早产及窒息缺氧史，3例产前均有羊水过多史，出生后口鼻大量泡沫，置入胃管困难。x线片见食管盲端位于T2～T3水平而腹部无充气。所有患儿均于出生后2～3d行第1次手术，采用单纯胃造瘘术，术中阻断胃远端，近端造影显示两盲端距离，证实两盲端距离为5～7个椎体，I期食管端端吻合不可能；术后予食管近端经鼻置管，每2～3h抽吸唾液，同时经胃造瘘进行肠道营养；第2次手术于12～16周后进行，经胸行食管食管吻合术。结果第1次手术时两盲端距离分别为7cm、5．5cm、5cm、4cm，术后经胃造瘘喂养；第2次手术时食管盲端均增粗明显，盲端间距均缩短，分别为5cm、4cm、3．5c、3cm，其中2例经松解周围粘连及肌层切开，完成一定张力下吻合。1例采用内牵引法，另1例行外牵引，5～7d后再次经胸行食管-食管端端吻合术。4例术后均以呼吸机辅助通气，其中3例发生吻合口漏，经保守治疗后痊愈。3例术后发生吻合口狭窄经胃镜下扩张好转，术后随访3个月至2年，2例存在胃食管返流，予保守治疗。结论对I型食管闭锁进行胃造瘘后延期手术可缩短食管盲端间距离，内牵引或外牵引法可在短期内诱导食管盲端迅速生长，为食管一食管吻合术提供可能。
Objective To present our experience for delayed primary anastomosis of type I congenital esophageal atresia. Methods A retrospective review of 4 patients with type I congenital esophageal alresia was conducted. The birth weights of the 4 females were 2.75, 2.30, 2.45, and 2.50 kilograms respectively. Gastrostomy was carried about two to three days after birth and the gap between the proximal and distal esophagus was measured radiology. The corrective operations were performed in the 12 to 16 weeks, which were anastomoses of esophageal- esophageal. Results At initial gastrostomy, the gap between the proximal and distal esophagus was respective 7.0, 5.5, 5.0, and 4.0 cm. After 12 to 16 weeks feeding through gastrostomy catheters, the segment was respective 5.0, 4.0, 3.5, and 3.0 cm. Two cases had anastomosis of esophageal- esophageal with esophageal myotomy. 1 ease had internal traction for 5 days and anastomosis with acceptable tension. Another case had external traction with sutures brought out the incision and increased the tension daily to stimulus the growth of proximal and distal esophagus. After 7 days, the anastomosis was done. There were 3 eases suffering from anastomotic leak, which were healed by non-operative methods. 3 eases had stenosis and were treated much better by dilating in the gastroscopy. In the follow-up of three months to two years, 2 cases existing gastroesophageal reflux with conservative treatments. Conclusions Delayed surgery can shorten the gap between the two ends in the treatment of type I congenital esophageal atresia. Internal traction or external traction may induce the blind end into growing in a brief time, which can provide the possibility for the esophageal-esophageal anastomosis.
出处
《临床小儿外科杂志》
CAS
2009年第6期17-20,共4页
Journal of Clinical Pediatric Surgery
基金
本项目由卫生部临床学科重点项目（2007353）和上海市卫生局重点项目（20082D001）资助
