Tao Junfeng,Huang Jinshi,Chen Kuai,et al.Comparison of management methods of congenital esophageal atresia with esophago tracheal fistula[J].Journal of Clinical Pediatric Surgery,2021,20(12):1122-1126.[doi:10.12260/lcxewkzz.2021.12.004]
先天性食管闭锁并食管气管瘘手术中瘘管处理方法的对比研究
- Title:
- Comparison of management methods of congenital esophageal atresia with esophago tracheal fistula
- 关键词:
- 食管闭锁/外科学; 手术后并发症/外科学; 食管气管瘘复发; 胸腔镜检查
- Keywords:
- Esophageal Atresia/SU; Postoperative Complications/SU; Recurrent Tracheoesophageal FistulaTracheoesophageal Fistula; Thoracoscopy
- 分类号:
- R725.621.3;R571;R726.1
- 摘要:
- 目的 探讨胸腔镜下食管闭锁手术中采取不同的食管气管瘘断端处理方法对手术后食管气管瘘复发的影响。方法 以2014年4月至2021年4月由江西省儿童医院新生儿外科完成的110例先天性食管闭锁胸腔镜手术患者为研究对象，将110例患者按照术中食管气管瘘断端处理方法的不同分为3组：A组40例，采取结扎缝扎各一道；B组40例，予Hem-o-lok夹夹闭；C组30例，采取连续缝合包埋。术后随访时间均超过6个月，无失访及死亡病例。统计分析3组患者手术后食管气管瘘复发例数、食管吻合口瘘发生例数以及术中食管气管瘘断端处理时间等。结果 110例患者中，9例食管气管瘘复发，总复发率8.2%；15例出现吻合口漏，总吻合口漏发生率13.6%。A、B、C组食管气管瘘复发例数分别为5例（5/40，12.5%），4例（4/40，10%），0例（0%）；吻合口漏的发生例数分别为6例（6/40，15%），5例（5/40，12.5%），4例（4/30，13.3%）；每两组之间比较采用χ2检验，C组食管气管瘘的复发率低于A、B组（P<0.05），3组间吻合口漏的发生率比较，差异无统计学意义（P>0.05）。A、B、C组处理食管气管瘘断端耗时分别为（15.5±4.5） min，（7.5±2.5） min，（26.5±5.5） min；每两组之间比较采用配对t检验，C组耗时高于A、B组。结论 食管闭锁手术中采用连续缝合包埋方法处理食管气管瘘断端，虽然较结扎缝扎各一道及Hem-o-lok夹夹闭的方法耗时更长，但能够避免或减少术后食管气管瘘的发生。由于目前该研究为单中心开展，样本量较小，其结论还有待多中心大数据临床研究的进一步论证。
- Abstract:
- Objective To explore the efficacies of different treatments for broken end of esophagotracheal fistula (ETF) in thoracoscopic esophageal atresia on its recurrence.Methods From April 2014 to April 2021, clinical data were retrospectively reviewed for 110 children with congenital esophageal atresia undergoing thoracoscopy.According to different treatments of ETF, they were divided into group A (n=40, one ligation and one suture), group B (n=40, clamping with Hem-o-lok) and group C (n=30, continuous suture embedding).The recurrence rate of postoperative ETF, the incidence of postoperative esophago anastomotic fistula and time to handle broken end of ETF were compared among three groups.Results During a follow-up period of over 6 months, there was no loss of follow-up or mortality.There were 9 recurrent ETF cases with an overall recurrence rate ofs 8.2%; Anastomotic leakage occurred in 15 cases with an overall incidence of anastomotic leakage of 13.6%.The recurrence rates of tracheal fistula of three groups were 5 (12.5%), 4(10%) and 0(0%); The incidence of anastomotic leakage was 6(15%), 5(12.5%) and 4(13.3%) respectively.And χ2 and t tests were utilized.The recurrence rate of tracheal fistula was lower in group C than that in group A/B (P<0.05); No significant difference existed in the incidence of anastomotic leakage among three groups (P>0.05).Time for dealing with brokcen end of ETF was (15.5±4.5), (7.5±2.5) and (26.5±5.5) min respectively.Paired t-test indicated that handling time was greater in group C than that in group A/B.Conclusion New treatment of ETF is more time-consuming than ligation/suture and Hem-o-lok clamping.However, it can avoid or lower the postoperative incidence of ETF.Due to a small number of case studies at a single center, larger clinical trials at multiple centers are required for verifications.
参考文献/References:
1 Bruch SW, Hirschl RB, Coran AG.The diagnosis and management of recurrent tracheoesophageal fistulas[J].J Pediatr Surg, 2010, 45(2):337-340.DOI:10.1016/j.jpedsurg.2009.10.070.
2 黄金狮, 华凯云.关于胸腔镜手术治疗先天性食管闭锁的几点思考[J].中华小儿外科杂志, 2020, 41(6):481-483.DOI:10.3760/cma.j.cn421158-20200508-00315. Huang JS, Hua KY.Several issues of thoracoscopy for congenital esophageal atresia[J].Chin J Pediatr Surg, 2020, 41(6):481-483.DOI:10.3760/cma.j.cn421158-20200508-00315.
3 Ghandour KE, Spitz L, Brereton RJ, et al.Recurrent tracheo-oesophageal fistula:experience with 24 patients[J].J Paediatr Child Health, 1990, 26(2):89-91.DOI:10.1111/j.1440-1754.1990.tb02393.x.
4 华凯云, 赵勇, 谷一超, 等.胸腔镜下食管闭锁修补术后食管气管瘘复发18例[J].中华小儿外科杂志, 2019, 40(6):499-502.DOI:10.3760/cma.j.issn.0253-3006.2019.06.004. Hua KY, Zhao Y, Gu YC, et al.Thoracoscopic repair of recurrent tracheoesophageal fistula after operations for esophageal atresia:a report of 18 cases[J].Chin J Pediatr Surg, 2019, 40(6):499-502.DOI:10.3760/cma.j.issn.0253-3006.2019.06.004.
5 Briganti V, Mangia G, Ialongo P, et al.Usefulness of large pleural flap for the treatment of children with recurrent tracheoesophageal fistula[J].Pediatr Surg Int, 2009, 25(7):587-589.DOI:10.1007/s00383-009-2399-6.
6 Rothenberg SS.Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula in neonates, first decade’s experience[J].Dis Esophagus, 2013, 26(4):359-364.DOI.org/10.1111/dote.12054.
7 Ein SH, Stringer DA, Stephens CA, et al.Recurrent tracheoesophageal fistulas seventeen-year review[J].J Pediatr Surg, 1983, 18(4):436-441.DOI:10.1089/lap.2009.0083.
8 Alslaim HS, Banooni AB, Shaltaf A, et al.Tracheoesophageal fistula in the developing world:are we ready for thoracoscopic repair?[J].Pediatr Surg Int, 2020, 36(5):649-654.DOI:10.1007/s00383-020-04639-7.
9 Coran AG.Redo esophageal surgery:the diagnosis and management of recurrent tracheoesophageal fistula[J].Pediatr Surg Int, 2013, 29(10):995-999.DOI:10.1007/s00383-013-3395-4.
10 van der Zee DC, Tytgat SHA, van Herwaarden MYA.Esophageal atresia and tracheo-esophageal fistula[J].Semin Pediatr Surg, 2017, 26(2):67-71.DOI:10.1053/j.sempedsurg.2017.02.004.
11 Rothenberg SS.Experience with thoracoscopic tracheal surgery in infants and children[J].J Laparoendosc Adv Surg Tech A, 2009, 19(5):671-674.DOI:10.1089/lap.2009.0083.
12 林阳文, 江怡, 王俊.食管闭锁重建术后食管功能评估的现状与发展[J].临床小儿外科杂志, 2021, 20(4):388-392.DOI:10.12260/lcxewkzz.2021.04.016. Lin YW, Jiang Y, Wang J.Current status and future developments of esophageal function after a reconstruction of esophageal atresia[J].J Clin Ped Sur, 2021, 20(4):388-392.DOI:10.12260/lcxewkzz.2021.04.016.
13 黄金狮.经胸腔镜手术治疗先天性食管闭锁并食管气管瘘[J].临床小儿外科杂志, 2014, 13(5):456-457.DOI:10.3969/j.issn.1671-6353.2014.05.026. Huang JS.Thoracoscopy for congenital esophageal atresia with esophagotracheal fistula[J].J Clin Ped Sur, 2014, 13(5):456-457.DOI:10.3969/j.issn.1671-6353.2014.05.026.
14 张旻中, 王俊, 蔡威.食管闭锁术后食管气管瘘复发的治疗进展[J].中华小儿外科杂志, 2016, 37(2):147-150.DOI:10.3760/cma.j.issn.0253-3006.2016.02.015. Zhang MZ, Wang J, Cai W.Treatment advances for recurrent tracheoesophageal fistula after operations for esophageal atresia[J].Chin J Pediatr Surg, 2016, 37(2):147-150.DOI:10.3760/cma.j.issn.0253-3006.2016.02.015.
15 冯翠竹, 李旭, 马继东, 等.H em-o-lok夹在胸腔镜治疗Ⅲ型食管闭锁中应用的初期探讨[J].中国微创外科杂志, 2016, 16(7):611-613.DOI:10.3969/j.issn.1009-6604.2016.07.009. Feng CZ, Li X, Ma JD, et al.Preliminary application of Hem-o-lok clips in thoracoscopic treatment of type Ⅲ esophageal atresia[J].Chinese Journal of Minimally Invasive Surgery, 2016, 16(7):611-613.DOI:10.3969/j.issn.1009-6604.2016.07.009.
16 Matsuoka K, Imanishi N, Yamada T, et al.Clinical results of bronchial stump coverage using free pericardial fat pad[J].Interact Cardiovasc Thorac Surg, 2016, 23(4):553-559.DOI:10.1093/icvts/ivw193.
17 Fukumoto Y, Matsunaga T, Shishido Y, et al.Successful repair using thymus pedicle flap for tracheoesophageal fistula:a case report[J].Surg Case Rep, 2018, 4(1):49.DOI:10.1186/s40792-018-0458-8.
18 Botham MJ, Coran AG.The use of pericardium for the management of recurrent tracheoesophageal fistula[J].J Pediatr Surg, 1986, 21(2):164-166.DOI:10.1016/s0022-3468(86)80074-4.
19 Smithers CJ, Hamilton TE, Manfredi MA, et al.Categorization and repair of recurrent and acquired tracheoesophageal fistulae occurring after esophageal atresia repair[J].J Pediatr Surg, 2017, 52(3):424-430.DOI:10.1016/j.jpedsurg.2016.08.012.
20 Cano Novillo I, Aneiros Castro B, Godoy Lenz J, et al.Thoracoscopic approach for complications after esophageal atresia repair:initial experience[J].Asian J Endosc Surg, 2020, 13(2):147-151.DOI:10.1080/13645706.2019.1621347.
21 Wheatley MJ, Coran AG.Pericardial flap interposition for the definitive management of recurrent tracheoesophageal fistula[J].J Pediatr Surg, 1992, 27(8):1122-1125.DOI:10.1016/0022-3468(92)90572-o.
22 梁靓, 谭征, 黄婷, 等.Ⅲ型先天性食管闭锁术后吻合口漏的相关营养评估研究[J].临床小儿外科杂志, 2020, 19(8):721-727.DOI:10.3969/j.issn.1671-6353.2020.08.012. Liang L, Tan Z, Huang T, et al.Nutritional evaluation of postoperative anastomotic leakage in children with type Ⅲ esophageal atresia[J].J Clin Ped Sur, 2020, 19(8):721-727.DOI:10.3969/j.issn.1671-6353.2020.08.012.
23 Aworanti O, Awadalla S.Management of recurrent tracheoesophageal fistulas:a systematic review[J].Eur J Pediatr Surg, 2014, 24(5):365-375.DOI:10.1055/s-0034-1370780.
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备注/Memo
收稿日期:2021-07-20。
基金项目:江西省卫生健康委普通科技计划（编号：20195540）
通讯作者:陶强,Email:taoqiang_2008@126.com