摘要
目的探讨围手术期管理对先天性食管闭锁术后并发症的影响因素，从而降低并发症的发生率。方法总结我科9年来收治食管闭锁病例225例进行回顾性分析，男149例，女76例，孕周32～41周，平均（37.9±2.7）周，早产儿49例，出生体质量1 740～4 400 g，平均（2 926±570） g。入院后行胸腹X线片、食管造影、胸部CT平扫＋三维重建检查，明确分型。Ⅰ型3例，Ⅴ型4例，Ⅲa型92例，Ⅲb型126例，其中Ⅲ型206例行一期经胸膜外入路食管气管瘘修补＋食管端端吻合术，12例经胸腔镜手术，分析术后并发症的发生情况，手术时机把握及开奶时间对其术后并发症发生率的影响。结果218例Ⅲ型EA手术患儿中治愈206例（94.5%）。发生吻合口漏46例（21.1%），其中Ⅲa型29例，Ⅲb型17例。吻合口狭窄53例（24.3%），其中Ⅲa型29例，Ⅲb型24例，33例曾发生吻合口漏，不同分型在吻合口漏、吻合口狭窄的发生率上的差异有统计学意义，出现吻合口漏的患儿更容易发生吻合口狭窄。大于7 d开始肠内营养组77例，其中吻合口漏12例（15.6%），吻合口狭窄19例（24.7%），住院时间（27.7±10.1） d，小于7 d开始肠内营养组21例，其中吻合口漏2例（9.5%），吻合口狭窄7例（33.3%），住院时间（23.4±8.5） d，不同开奶时间患儿的吻合口漏、吻合口狭窄的发生率没有统计学差异，不同开奶时间患儿的住院时间长短差异有统计学意义。小于7 d内手术161例，发生吻合口漏26例（16.1%），大于7 d内手术57例，发生吻合口漏20例（35.1%）；其机械通气时间长短分别为（4.2±2.1） d，（6.4±2.3） d，差异均有统计学意义。结论加强围手术期管理，早期诊断，尽早手术，可以减少术后并发症的发生率，改善预后；术中置入空肠营养管可以缩短住院时间，减少长期应用肠外营养相关并发症，改善患儿营养状况，开展
ObjectiveTo explore the influencing factors of perioperative management on complications after operations for congenital esophageal atresia （CEA） and thus lower the incidence of complications.MethodsClinical data were collected for 225 hospitalized CEA cases for 9 years. Chest and abdominal plain films, esophagectomy, chest computed tomography scan and three-dimensional reconstruction examination were performed after admission for clinical typing. The clinical types were Ⅰ （n=3）, Ⅲa （n=92）, Ⅲb （n=126） andⅤ （n=4）. Among them, 206 patients underwent extraperitoneal repair of esophageal tracheal fistula and esophageal anastomosis while another 12 cases underwent thoracoscopy. The incidence of postoperative complications and the effects of operative duration and the time of oral feeling of milk on the incidence of postoperative complications were analyzed.ResultsSeventy-seven cases began enteral nutrition after 7 days and there were anastomotic stenosis （n=12） and anastomotic leakage （n=19）; 21 cases began enteral nutrition within 7 days and there were anastomotic stenosis （n=2） and anastomotic leakage （n=7）. And 161 cases accepted operation within 7 days and anastomotic leakage occurred in 26 cases; 57 cases accepted operation within 7 days and anastomotic leakage occurred in 20 cases. The durations of mechanical ventilation were 4.2±2.1 and 6.4±2.3 days respectively.ConclusionsStrengthening perioperative management and early surgery may significantly reduce the incidence of anastomotic leakage and shorten the duration of postoperative mechanical ventilation. Physicians should have sufficient endoscopic experiences and strictly control indications.
作者
潘登
王献良
邵雷朋
杨敏
孙忠源
穆鑫
谢文雅
Deng;Wang Xianliang;Shao Leipeng;Yang Min;Sun Zhongyuan;Mu Xin;Xie Wenya(Department of Neonatal Surgery, Affiliated Children ＇ s Hospital, Zhengzhou University, Henan Children＇s Hospital, Municipal Children ＇ s Hospital, Zhengzhou 4500]8, Chin)
出处
《中华小儿外科杂志》
CSCD
北大核心
2018年第4期260-265,共6页
Chinese Journal of Pediatric Surgery
关键词
食管闭锁
气管食管瘘
围手术期处理
Esophageal atresia
Tracheoesophageal fistula
Perioperative management
