摘要
目的 总结Ⅲ型先天性食管闭锁的围产期诊断、围手术期治疗和并发症的处理经验.方法 回顾性分析本院自2004年7月至2013年7月收治的75例Ⅲ型先天性食管闭锁患儿临床资料.经产前诊断、生后食管造影及CT诊断明确并初步分型,术前持续抽吸胃管、抗炎治疗,及时行Ⅰ期食管气管瘘结扎＋食管吻合术,术后留置胃管、胸腔引流管,抗炎及静脉营养支持治疗.第7天行食管造影检查,有食管吻合口瘘者予鼻饲及静脉营养支持治疗.常规于术后1个月复查造影,证实存在吻合口狭窄者行食管扩张术.按计划随访.结果 75例中,出车转运61例,成功率100%;产前诊断11例,诊断率14.7%（11/75）.75例均合并不同程度肺炎,36例合并其他先天畸形,占48%（36/75）,5例确诊为VACTER综合征,占6.7%（5/75）.术前放弃治疗11例,接受手术64例,术后放弃4例,治愈60例,治愈率93.8%（60/64）.54例经胸膜外入路,10例经胸入路.Ⅲa型23例,Ⅲb型41例.出现食管吻合口瘘10例（15.6%,10/64）,放弃4例,6例经保守治疗痊愈;吻合口狭窄23例（35.9%,23/64）,行球囊扩张术（平均2.2±1.5次）后治愈.术后随访1个月至8年,5例有胃食管反流,3例有气管软化症,所有病例均生长发育良好,无吞咽困难.结论 通过围产期早期诊断,生后及时手术治疗,成熟缜密的手术技术,加强围手术期管理,以及对出现的术后并发症及时处理,可以提高CEA 的存活率及生存质量.
Objetive To evaluate our experience of perinatal diagnosis, perioperative treatment for com- plications of type Ill Congenital Esophageal Atresia （CEA）. Methods The records of 75 infants with CEA from July 2004 to July 2013 were reviewed retrospectively. Base data, associated anomalies, details of manage- ment, complications, and outcomes were examined. Results Totally 75 consecutive infants with CEA were i- dentified, of which 61 were successfully transported from other hospitals, 11 （14.7%） were prenatally diag- nosed. All of them suffered from pneumonia, 36（48% ） associated with other congenital anomalies, 5 （6.7%） had vertebral anomaly anal atresia cardial anomaly renal or radial anomaly（VACTER）, association. 64 accept- ed operations while 11 were abandoned preoperatively and 4 postoperatively. 60 （93.8%） were cured. 54 per- formed in extrapleural approach and 10 in transpleural approach. 23 were type IIIa and 41 were type HI b. The follow-up period for all the patients was in the range of 1 month to 8 years, and all grew well. Complications in- cluded anastomotic leakage （ 15.6% , 6 recovered after conservative treatment and 4 were abandoned） , anasto- motic stricture （35.9% , all recovered after balloon dilatations）, and gastroesophageal reflux （ 5 cases）, tra- cheomalacia（3 cases）. Conclusions It is suggested that perinatal early diagnosis, timely postpartum opera- tion, careful surgery technique, adequete perioperative treatment and timely treatment for complications may be beneficial to improving cure rate and quality of life in infants with CEA.
出处
《临床小儿外科杂志》
CAS
2013年第6期448-453,共6页
Journal of Clinical Pediatric Surgery
