先天性食管闭锁73例诊治分析
- 摘要:
- 目的 探讨先天性食管闭锁患儿手术治疗及术前、术后处理策略，以提高生存率，降低术后并发症。 方法 1995年10月至2009年6月共收治先天性食管闭锁患儿73例，男51例，女22例，男∶女约2.3∶1，低体重儿（< 2 500 g）14例。首次住院治疗患儿平均入院日龄为（3.27±3.16）d。8例放弃手术及2例未手术患儿死亡， 63例均行I期食管重建术。 结果 63例手术患儿按Gross分型：I型6例，Ⅲa型11例，Ⅲb型46例。合并其他先天性畸形41例，主要包括先天性心脏病30例，肛门闭锁5例，肛门狭窄1例，肺发育不良2例，环状胰腺1例。2例术后放弃治疗，其余61例手术病例术后治愈率为100%。术后发生肺炎47例（74.60%），吻合口狭窄36例（57.14%），吻合口漏11例（17.46%）。 结论 早诊断、加强围手术期管理以及成熟的吻合技术是提高先天性食管闭锁患儿手术成功率的关键。对长段型食管闭锁行胃、胃管、结肠代食管术是有效的方法。营养支持是提高手术成功率的保障。
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备注/Memo
作者单位：上海交通大学医学院附属新华医院小儿外科（上海，200092）