Xi Linyun,Wu Chun,Pan Zhengxia,et al.Analysis of risk factors of complications in type Ⅲ congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,,18():462-466.[doi:10.3969/j.issn.1671-6353.2019.06.006]
Analysis of risk factors of complications in type Ⅲ congenital esophageal atresia
- Keywords:
- Esophageal Atresia/SU; Esophageal Atresia/CO; Postoperative Complications; Esophageal Atresia/ET
- CLC:
- R726.1;R655.4;R571+.1
- Abstract:
- Objective To explore the complications and influencing factors of type Ⅲ congenital esophageal atresia (CEA). Methods A retrospective analysis was performed for 64 cases of concurrent Ⅲ CEA from January 1,2013 to December 31,2014.The clinical types were ⅢA (n=21) and ⅢB (n=43).All of them underwent resection of tracheoesophageal fistula and anastomosis of esophagus.The gestational age of children was 33.3 to 41.6 weeks and their birth weights were between 2200 to 4000 grams.There were also other congenital malformations (n=39),pneumonia (n=33) and hypoproteinemia (n=20).The relationship of type ⅢA/B was analyzed between anastomotic leak,esophageal stricture and gestational age,birth weight,associated congenital malformations,pneumonia and hypoproteinemia.Results In type Ⅲ A group,there were anastomotic leak (n=7) and esophageal stricture (n=11).No significant difference of anastomotic leak or esophageal stricture existed in estational age,birth weight or associated congenital malformations.However,there was significant difference in hypoproteinemia.In type ⅢB group,there were anastomotic leak (n=3) and esophageal stricture (n=3).Significant difference of anastomotic leak or esophageal stricture was absent in terms of gestational age,birth weight and associated congenital malformations.However,there was significant difference in hypoproteinemia. Conclusion Gestational age,birth weight and associated congenital malformations are not risk factors of anastomotic leak or esophageal stricture.Anastomotic tension and hypoproteinemia are risk factors.Moreover,anastomotic leak is a risk factor of esophageal stricture.
References:
1 Engum SA,Gmsfeld JL,West KW,et al.Analysis of morbidity and mortality in 227 cases of esophageal atresia and/or tracheoesophageal fistula over two decades[J].Arch Surg,1995,130(5):502-508.
2 Zeng Z,Liu F,Ma J,Fang Y,et al.Outcomes of primary gastric transposition for long-gap esophageal atresia in neonates[J].Medicine (Baltimore),2017,96(26):e7366.DOI:10.1097/MD.0000000000007366.
3 Sparey C,Jawaheer G,Barrett AM,et a1.Esophageal atresia in the northern region congenital anomaly survey,1985-1997:prenatal diagnosis and outcome[J].Am J Obstet Gynecol,2000,182(2):427-431.DOI:10.1016/s0002-9378(00)70234-1.
4 Spitz L.Esophageal atresia:past,present,and future[J].J Pediatr Surg,1996,31(1):19-25.
5 Chittmittrapap S,Spitz L,Kiely EM,et al.Anastomotic Leakage following surgery for esophageal atresia[J].J Pediatr Surg,1992,27(1):29-32.
6 Kovesi T,Rubin S.Long term complications of esophageal atresia and/or tracheoesophageal fistula[J].Chest,2004,126(3):915-925.DOI:10.1378/chest.126.3.915.
7 Rony Sfeir,Arnaud Bonnard,Naziha khen-Dunlop,et al.Esophageal atresia:Data from a national cohort[J].J Pediatr Surg,2013,48(8):1664-1669.DOI:10.1016/j.jpedsurg.2013.03.075.
8 赵捷,朱小瑜,杨传忠,连朝辉.48例先天性食管闭锁手术后并发症的分析[J].中国优生与遗传杂志,2010,18(7):102-103.DOI:10.13404/j.cnki.cjbhh.2010.07.069. Zhao J,Zhu XY,Yang CZ et al.Postoperative complications of postoperation in 48 infants with congenital esophageal atresia[J].Chinese Journal of Birth Health & Heredity,2010,18(7):102-103.DOI:10.13404/j.cnki.cjbhh.2010.07.069.
9 秦臻.先天性食管闭锁手术治疗与术后管理的相关临床研究[D].上海交通大学,2014. Qin Z.Clinical research on surgical treatment and postoperative management of congenital esophageal atresia[D].Shanghai Jiao Tong University,2014.
10 温艺超.缺损食管肌层修复过程与新生食管形成过程的对照研究[D].广州医学院,2009. Wen YC.Control study between esophageal repair with muscular layer defects and neoesophageal formation[D].Guangzhou Medical University,2009.
11 李彦强.先天性食管闭锁13例临床诊疗总结[D].广西医科大学,2014. Li YQ.Summary of clinical diagnosis and treatment of congenital esophageal atresia:a report of 13 cases[D].Guangxi Medical University,2014.
12 赵瑞,郑珊,沈淳,等.Ⅲ型食管闭锁术后吻合口漏的临床分析[J].中华小儿外科杂志,2008,29(2):707-710.DOI:10.3760/cma.j.issn.0253-3006.2008.12.002. Zhao R,Zheng S,Shen C,et al.Diagnosis and treatment of postoperative leakage of esophageal anastomosis in patients with esophageal atresia of type Ⅲ[J].Chin J Pediatr Surg.2008,29(12):707-710.DOI:10.3760/cma.j.issn.0253-3006.2008.12.002.
13 Upadhyaya VD,Gangopadhyaya AN,Gupta DK,et al.Prognosis of congenital tracheoesophageal fistula with esophageal atresia on the basis of gap length[J].Pediatr Surg Int,2007,23(8):767-771.
14 Boia ES,Nicodin A,Popoiu MC,et al.An effective method to release anastomotic tension after repair of esophageal atresia using a Foley catheter[J].Chirurgia (Bucur),2013,108(2):189-192.
15 樊纬,黄金狮,陈快,等.型食管闭锁治疗中食管内张力延长技术的应用[J].临床小儿外科杂志,2017,16(4):360-363.DOI:10.3969/j.iss n.1671-6353.2017.04.011. Fan W,Huang JS,Chen K,et al.Application of tension-extension technique in the treatment of typeⅠcongenital esophageal atresia[J].Clin Ped Sur,2017,16(4):360-363.DOI:10.3969/j.iss n.1671-6353.2017.04.011.
Memo
收稿日期:2018-09-05。
基金项目:国家临床重点专科建设项目（国卫办医函[2013]544）
通讯作者:吴春,Email:wuchun007@sina.com