摘要
目的探讨经胸腔镜手术治疗先天性食管闭锁并食管气管瘘的手术经验及疗效。方法回顾性分析我院2010年1月至2014年1月间，运用经胸腔镜手术治疗先天性食管闭锁并食管气管瘘69例的临床资料。其中，男42例，女27例；日龄1～48d；体重1．4～3．5kg。术前均通过食管造影明确诊断，常规完成心脏及腹部超声检查。手术采用3孔法，在胸腔镜下结扎切断奇静脉，结扎或缝扎食管-气管瘘，游离近、远侧食管盲端，5-0可吸收线间断缝合食管完成吻合，术毕留置胸腔引流管。结果69例患儿中63例在胸腔镜下一期完成食管吻合术，手术时间73～205min，平均（123±39）min；1例输浓缩红细胞0．2g位，余手术出血量均〈10ml，未输血；术后呼吸机支持时间（2．7±2．3）d。4例行需行分期手术，中转开胸2例，术后吻合口漏9例，其中1例放弃治疗，余8例经保守治疗治愈。术后随访2个月～3年9个月，食管吻合口狭窄需扩张治疗的病例25例，分别予以沙氏探条扩张1～18次，1例重度胃食管反流，行腹腔镜下Nissen手术治愈。食管气管瘘复发4例（其中1例死亡，3例再次开胸手术修补治愈）。本组死亡或放弃治疗6例。结论胸腔镜手术治疗先天性食管闭锁并食管气管瘘应用初期存在与手术技术相关并发症，选择适宜器械、加强腔镜操作训练与经验交流可缩短学习曲线。
Objective To evaluate our experiences in thoracoscopic repair of congenital esophageal atresia with tracheoesophageal fistula （EATEF） in neonates. Methods The 3-trocar thoracoscopic procedures of esophageal anastomosis and fistula ligation were performed for 69 neonates from January 2010 to January 2014. There were 42 males and 27 females with an age range of 1-48 days and a body weight of 1.4 - 3.5 kg. In all cases, the diagnosis was made based on esophageal radiological contrast plus echocardiography and abdominal ultrasonography. At the end of procedure, a chest tube was implanted. Results A total of 69 patients underwent thoracoscopic repair. And 63 had one-stage repair successfully. Two operations were converted into open thoracotomy and 4 cases had to be staged due to a long gap between 2 esophageal segments. The average operative duration was 123 ± 39 （73 - 205） min. The amount of bleeding was （10 ml except for 40 mI in one case. The mean length of mechanical ventilation was （2. 7± 2. 3） days. Nine cases had anastomotic leak. The follow-up period was 2 - 45 months. And 25 neonates developed anastomotic stricture and required esophageal dilatation 1 to 18 times. Recurrent fistula between esophagus and trachea developed in 4 cases. Later one case required laparoscopic fundoplication. And six cases died. Conclusions The thoracoscopic procedure is both safe and effective in the treatment of EATER Initial attempts result in a higher incidence of such complications as stricture and leak. Better outcomes may be achieved with technique refinements.
出处
《中华小儿外科杂志》
CSCD
北大核心
2014年第6期414-418,共5页
Chinese Journal of Pediatric Surgery
关键词
胸腔镜检查
食管闭锁
食管气管瘘
Thoracoscopy
Esophageal atresia
Tracheoesophageal fistula
