Huang Hua,Ma Shaobin,Chen Xuanxuan,et al.Analysis of managing type Ⅴ congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,2025,(06):577-581.[doi:10.3760/cma.j.cn101785-202410015-013]
Ⅴ型先天性食管闭锁诊治分析
- Title:
- Analysis of managing type Ⅴ congenital esophageal atresia
- Keywords:
- Esophageal Atresia; Congenital; Surgical Procedures; Operative; Thoracic Surgery; Video-Assisted; Thoracoscopes; Flexible Bronchoscope; Treatment Outcome; Postoperative Complications
- 摘要:
- 目的 总结Ⅴ型先天性食管闭锁(congenital esophageal atresia type V,V-CEA)的临床诊治经验。方法 回顾性分析郑州大学第三附属医院于2020年9月至2024年6月收治的8例Ⅴ-CEA患儿临床资料。收集患儿一般资料(性别、年龄、体重、临床表现、辅助检查)、手术情况(手术年龄、手术方式、瘘管位置、并发症、再次手术)及预后等。结果 8例患儿中,男3例、女5例。日龄≤28天4例,29天至1岁3例,≥1岁1例。体重1.9~11 kg。均因生后出现呛咳、呼吸困难、呕吐入院。术前食管造影、胸部CT三维重建、纤维支气管镜检查诊断Ⅴ-CEA例数分别为4例、2例、8例。瘘管位于第2胸椎5例,第7颈椎至第1胸椎2例,第2胸椎至第3胸椎1例。入院后4~24 d内行经胸腔入路(6例)或左侧颈部入路(2例)手术,其中胸腔镜联合纤维支气管镜手术(双镜联合)4例,双镜联合中转开胸手术1例,开胸联合纤维支气管镜手术1例,颈部入路联合纤维支气管镜手术2例。术后2例出现声嘶伴吞咽障碍,无一例吻合口瘘或瘘管复发。随访1~18个月,1例于术后4个月复发并于本院再次手术;1例于术后3个月复发并于外院再次手术;2例出现轻微呛咳,于18个月后症状逐渐消失;其余4例无明显并发症。结论 胸腔镜手术或开放手术中,联合纤维支气管镜进行Ⅴ-CEA瘘管定位及修补术安全可行,具有快速精准定位瘘管、降低手术操作难度、节省手术时间等优点,术中缝扎离断瘘管并修补气管侧及食管侧瘘口,可以有效减少术后复发。
- Abstract:
- Objective To summarize the clinical diagnosis and treatment experience of congenital esophageal atresia type V (V-CEA). Methods A retrospective analysis was performed for the relevant clinical data of 8 V-CEA children admitted into Third Affiliated Hospital of Zhengzhou University from September 2020 to June 2024.General data (gender,age,weight,clinical manifestations & auxiliary examinations),as well as surgical and prognostic data (age at surgery,surgical approach,fistula location,complications,reoperation & prognosis) were retrospectively reviewed. Results Eight children were hospitalized for postnatal choking cough,dyspnea and vomiting.There were 3 boys and 5 girls.The age range was ≤ 28 day (n=4),29 day to 1 year (n=3) and ≥ 1 year (n=1).Weight ranged from 1.9 to 11 kg.Ⅴ-CEA was detected by preoperative esophageal radiography (n=4),chest CT 3D reconstruction (n=2) and fiberoptic bronchoscopy (n=8).Fistulas were located at the 2nd thoracic vertebra (n=5),between C7 and T1 (n=2) and between T2 and T3 (n=1).Within 4-24 days of admission,transthoracic (n=6) and left cervical (n=2) approaches were employed.The procedures included thoracoscopic plus fiberoptic bronchoscopy (double-mirror,n=4),conversion from double-mirror into thoracotomy (n=1),thoracotomy plus fiberoptic bronchoscopy (n=1) and cervical approach plus fiberoptic bronchoscopy (n=2).Postoperatively,2 cases developed hoarseness with dysphagia.Multiple esophageal radiographies and bronchoscopies showed no anastomotic fistula or recurrence.During follow-ups of (1-18) month,one recurrent case each at Month 3/4 was reoperated.Two cases of mild choking cough gradually resolved after 18 months and the remainders had no obvious complications. Conclusions During thoracoscopy or open surgery,combining fiberoptic bronchoscopy is both safe and feasible for localizing and repairing Ⅴ-CEA fistula.It can quickly and accurately localize fistula,lower operative difficulties and shorten operative duration.During operation,ligating and dividing fistula and repairing fistula at tracheal and esophageal sides may effectively reduce the postoperative recurrence of fistula.
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备注/Memo
收稿日期:2024-10-9。
通讯作者:黄华,Email:hhuang0989@163.com