Xu Xinli,Wang Haojie,Zhang Zhichao,et al.Comparative study of thoracoscopy and thoracotomy in the treatment of congenital esophageal atresia complicated with esophagotracheal fistula.[J].Journal of Clinical Pediatric Surgery,,17():184-189.
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Comparative study of thoracoscopy and thoracotomy in the treatment of congenital esophageal atresia complicated with esophagotracheal fistula.

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第17卷 Number: 2018 03 Page: 184-189 Column: 专题讨论 Date of publication: 2018-03-28
Author(s):
Xu Xinli1; Wang Haojie2; Zhang Zhichao1; Wang Min3.
1. Department of Cardiothoracic Surgery, First Municipal Peoples Hospital, Urumqi 830011, China;
Keywords:
Thoracoscopes;  Esophageal Atresia;  Tracheoesophageal Fistula;  Therapeutic Uses
Document code:
A
Abstract:
ObjectiveTo explore the clinical value of thoracoscopy in the treatment of congenital esophageal atresia (CEA) complicated with esophagotracheal fistula (ETF). MethodsFortyeight CEA/ETF children were operated from February 2014 to February 2017. Twentyeight underwent traditional thoracic surgery (traditional group) while another 20 cases had thoracoscopy (thoracoscopy group). The clinical efficacies of two methods were compared and the levels of pain, stress and other related blood parameters before and after operation in two groups were detected and compared.ResultsThe amount of operative bleeding was significantly lower in thoracoscopy group than that in traditional group (t=14.585,P<0.05). No significant difference existed in operative duration, blindend distance and postoperative breathing machine using time between two groups (P>0.05). In thoracoscopy group, 20 patients were successfully operated and there was no conversion into thoracotomy; in traditional group, 2/28 patients underwent gastrostomosis. Before operation, no significant intergroup differences existed in serum levels of nitrogen oxide (NO), interleukin1β(IL1β), interleukin6 (IL6), 5hydroxytryptamine (5HT) or tumor necrosis factoralpha (TNFα)(P>0.05); at 12 h and 24 h postoperation, the serum levels of NO, IL1β, IL6, 5HT and TNFαwere significantly lower in thoracoscopy group than those in traditional group (P<0.05); After operation, the complication rates of thoracoscopy and traditional groups were 35% and 28.57% respectively. No significant intergroup difference existed in the incidence of operative complications (χ2=1.222,P=0.269). The cure rate was 90% in thoracoscopy group versus 92.86% in traditional group. The difference was not statistically significant (χ2=0.125, P=0.724).ConclusionAs compared with thoracotomy, thoracoscopy offers such advantages as reducing the amount of intraoperative bleeding, effectively reducing postoperative inflammation, pain and stress response and improving prognosis. It has the value of clinical popularization.
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