Zhao Yong,Hua Kaiyun,Li Shuangshuang,et al.Clinical diagnosis and treatment of congenital esophageal atresia type Ⅳ[J].Journal of Clinical Pediatric Surgery,2019,18(10):874-877,883.[doi:10.3969/j.issn.1671-6353.2019.10.015]
先天性Ⅳ型食管闭锁的临床诊治分析
- Title:
- Clinical diagnosis and treatment of congenital esophageal atresia type Ⅳ
- 分类号:
- R726.1;R655.4
- 摘要:
- 目的 探讨先天性Ⅳ型食管闭锁的临床特点、诊断及治疗原则。方法 回顾性分析2017年6月至2018年6月首都医科大学附属北京儿童医院新生儿外科明确诊断并治疗的6例先天性Ⅳ型食管闭锁患儿的临床资料。其中男童4例，女童2例，年龄范围2 d至4岁7个月。术前行食管造影6例，电子纤维支气管镜检查6例，CT检查2例。结果 本组5例患儿初次诊断为先天性Ⅲ型食管闭锁，行手术治疗后饮水、饮奶仍有呛咳症状，反复肺炎。食管造影明确诊断为先天性Ⅳ型食管闭锁3例；电子纤维支气管镜明确诊断为先天性Ⅳ型食管闭锁6例；手术入路4例经颈部，1例经胸腔。1例为新生儿期明确诊断，食道造影及电子纤维支气管镜均考虑Ⅳ型，手术先行远端食管气管瘘结扎术+食管端端吻合术，家长因经济条件放弃治疗。其余5例手术治疗后，全部获得随访，吻合口狭窄1例，扩张4次治愈，无食管气管瘘复发，生长发育正常。结论 先天性Ⅳ型食管闭锁近端瘘管易漏诊，明确诊断后经手术治疗效果良好。
- Abstract:
- Objective To explore the clinical features,diagnostic and therapeutic principles of congenital esophageal atresia type Ⅳ.Methods Retrospective analysis was conducted for the clinical data of children with congenital esophageal atresia type Ⅳ from June 2017 to June 2018.There were 4 boys and 2 girls with an age range of 2 days to 55 months.The examinations included esophageal angiography & electron fiber bronchoscopy (n=6) and computed tomography (n=2).Results Five children with an initial diagnosis of congenital esophageal atresia type Ⅲ were operated.Severe cough persisted during drinking water and milk and recurrent pneumonia.A definite diagnosis was made by esophageal angiography in 3 cases.Operations were performed through neck (n=4) and thoracic cavity (n=1).One case was diagnosed during neonatal period and type Ⅳ confirmed by esophagography and electronic fiberoptic bronchoscopy.Distal endotracheal esophageal fistula ligation plus esophageal end-to-end anastomosis was performed.Parents gave up treatment due to economic difficulties.During follow-ups,the remaining 5 cases recovered well.One case of anostomotic stenosis was cured after four dilatations.There was no recurrence of tracheo-esophageal fistula.Growth and development were normal.Conclusion Proximal fistula of congenital esophageal atresia type Ⅳ may be easily missed and its surgery has an excellent outcome after a definite diagnosis.
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备注/Memo
收稿日期:2019-02-27。
通讯作者:黄金狮,Email:jsdr2002@126.com