Li Ming,Zhou Chonggao,Xiao Yong,et al.Clinical characteristics, diagnosis and treatment of type-Ⅲ Esophageal Atresia complicated by gastric perforation[J].Journal of Clinical Pediatric Surgery,,20():1132-1136.[doi:10.12260/lcxewkzz.2021.12.006]
Clinical characteristics, diagnosis and treatment of type-Ⅲ Esophageal Atresia complicated by gastric perforation
- CLC:
- R571;R573
- Abstract:
- Objective To study the clinical characteristics, diagnosis and treatment and prognosis of type-Ⅲ esophageal atresia (EA) complicated by gastric perforation.Methods From January 2007 to January 2021, a total of 7 children with type-Ⅲ EA complicated by gastric perforation were recruited, and their managements and prognosis were analyzed based on follow-up data.6 boys and 1 girl with an age range from 1 to 3 days were included.The clinical symptoms included dyspnea (n=3), polypne and cyanosis (n=3), vomiting (n=1).Patients were transferred to our hospital because of suspected diagnosis of EA, and 6 of them were intubated and mechanically ventilated preoperatively.The diagnosis of type-Ⅲ EA was confirmed by esophagography.Patients had a sudden abdominal distention and aggravated respiratory distress, and their general condition deteriorated.Pneumoperitoneum detected by X-ray scan was thought to be caused by air-related gastric perforation through the fistula.As an emergency measure, a local anesthetic abdominal puncture was performed at the bedside, and all patients showed improvement in respiratory distress and oxygen saturation.4 children received emergency surgery, and 3 of them underwent thoracoscopic ligation of tracheoesophageal fistula and oesophageal anastomosis followed by laparotomy and closure of the perforation of the stomach, the other one received thoracotomy with ligation of tracheoesophageal fistula and oesophageal anastomosis followed by laparotomy and closure of the perforation of the stomach.Results No anastomosis leakage occurred after surgery, and all 4 children recovered well and were discharged.During 1-2 years’ follow-up, 1 children showed anastomosis stenosis and was cured with the treatment of balloon dilation, and no recurrence of tracheoesophageal fistula was observed.All children are fed orally with good growth and development and satisfied weight gain.Conclusion The incidence of type-Ⅲ EA complicated by gastric perforation is low, but the patient’s general condition deteriorates rapidly and the diagnosis and treatment are always difficult.The prognosis of type-Ⅲ EA complicated by gastric perforation is good if patients received effective treatment, abdominal puncture and aspiration are effective emergency treatment, and it is feasible to perform thoracoscopic ligation of tracheoesophageal fistula and oesophageal anastomosis followed by laparotomy and closure of the perforation of the stomach.
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Memo
收稿日期:2021-03-26。
基金项目:湖南省出生缺陷协调防治科技重大专项（编号：2019SK1010）
通讯作者:周崇高,Email:zhouchonggao@sina.com