Yuan Like,Xiao Shangjie,Xu Lu,et al.Clinical features and prognostic factors of congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,2023,22(04):323-328.[doi:10.3760/cma.j.cn101785-202107026-005]
先天性食管闭锁的临床特征及预后影响因素分析
- Title:
- Clinical features and prognostic factors of congenital esophageal atresia
- Keywords:
- Esophageal Atresia; Postoperative Complications; Diagnosis; Surgical Procedures; Operative; Prognosis
- 摘要:
- 目的 探讨先天性食管闭锁(congenital esophageal atresia,CEA)的临床特征以及预后影响因素,为CEA的临床诊断、治疗决策以及预后评估提供参考。方法 回顾性分析2014年1月至2020年12月广东省妇幼保健院新生儿外科收治的285例CEA患儿临床资料,其中男176例,女109例;早产64例;出生体重(2 740±506)g;195例伴发畸形。按Gross分型:Ⅰ型13例、Ⅱ型2例、Ⅲ型264例、Ⅳ型2例、Ⅴ型4例。总结分析患儿一般资料、治疗效果以及并发症情况。结果 34例因早产、低出生体重或伴发畸形而放弃治疗。251例行手术治疗,其中241例(96.02%)存活(存活组),10例(3.98%)死亡(死亡组)。死亡组与存活组在性别分布及伴发畸形情况(先天性心脏病、直肠肛门畸形、其他消化道畸形、消化道穿孔)上比较,差异无统计学意义(P＞0.05);而两组早产、极低出生体重(＜1 500 g)占比差异有统计学意义(P＜0.05)。手术后并发症包括吻合口漏40例(40/251)、吻合口狭窄62例(62/251)、食管气管瘘8例(8/251)。230例Ⅲ型CEA中,123例行胸腔镜手术,107例行开胸手术,两种手术吻合口漏(χ2=0.413,P＝0.520)、吻合口狭窄(χ2=0.302,P＝0.583)、食管气管瘘复发(χ2=3.016,P＝0.082)的发生率、治愈率(χ2=0.431,P＝0.512)差异均无统计学意义。结论 CEA伴发先天性心脏病、直肠肛门畸形、其他消化道畸形及消化道穿孔与CEA预后不良无关,早产、极低出生体重与CEA预后不良相关。Ⅲ型CEA行胸腔镜手术不会增加并发症的发生率,但仍需远期随访及多中心研究进一步验证。
- Abstract:
- Objective To explore the clinical features and prognostic factors of congenital esophageal atresia (CEA) to provide references for clinical diagnosis,treatment decision-making and prognostic evaluations.Methods Retrospective analysis was conducted for clinical data of 285 CEA patients from January 2014 to December 2020.There were 176 boys and 109 girls with a birth weight of (1 080-3 980)(2 740±506) gram.And 64 cases were premature and 195 cases associated with other system malformation.Gross types were Ⅰ(n=13),Ⅱ(n=2),Ⅲ(n=264),Ⅳ(n=2) and Ⅴ(n=4).Results Thirty-four cases gave up surgery because of premature birth,low birth weight or associated malformations.Among 251 operated cases,241(96.02%) survived and 10(3.98%) died.No statistically significant differences existed in gender and associated malformation (congenital heart disease,anal atresia,digestive tract malformation & digestive tract perforation) between death and survival group (P>0.05); statistically significant differences existed in premature birth and very low birth weight (P<0.05).Postoperative complications included esophageal anastomotic leakage (n=40,15.94%),esophageal anastomotic stenosis (n=62,24.70%) and esophagotracheal fistula (n=8,3.19%).Among 230 cases of type Ⅲ,thoracoscopy (n=123) and thoracotomy (n=107) were performed.No significant inter-group differences existed in anastomotic leakage (χ2=0.413,P=0.520),anastomotic stenosis (χ2=0.302,P=0.583),esophagotracheal fistula recurrence (χ2=3.016,P=0.082) or cure rate (χ2=0.431,P=0.512).Conclusion Not associated with congenital heart disease,anal atresia,gastrointestinal malformation or digestive tract perforation,poor prognosis of CEA is correlated with preterm birth and very low birth weight.Thoracoscopy for type III CEA does not increase the probability of complications.However,long-term follow-ups and multi-center studies are still required.
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备注/Memo
收稿日期:2021-7-14。
基金项目:广州市科技计划项目(201804010290)
通讯作者:肖尚杰,Email:drsiow@163.com