Zhang Yuxi,Mo Xuming,Sun Jian,et al.The applied study of thoracoscopy during thoracoscopic surgical repair of typeⅢ esophageal atresia with tracheoesophageal fistula.[J].Journal of Clinical Pediatric Surgery,2018,17(03):170-173.
胸腔镜在Ⅲ型食管闭锁合并气管食管瘘修补术中的应用研究
- Title:
- The applied study of thoracoscopy during thoracoscopic surgical repair of typeⅢ esophageal atresia with tracheoesophageal fistula.
- Keywords:
- Esophageal Atresia; Tracheoesophageal Fistula; Thoracoscopes; Infant; Newborn
- 文献标志码:
- A
- 摘要:
- 目的 探讨胸腔镜在Ⅲ型食管闭锁合并气管食管瘘修补术中的应用价值。 方法 回顾性分析２０１５ 年６ 月至２０１８ 年１ 月采用胸腔镜手术治疗的２２ 例Ⅲ型食管闭锁合并食管气管瘘患儿临床资料，其中男性１２ 例，女性１０ 例；手术年龄２ ～ ９ ｄ，平均手术年龄（ ４． ２７ ± １． ８１） ｄ，体质量１． ５ ～４． ０５ ｋｇ，平均体质量（２． ４４ ±０． ６８） ｋｇ。术前均经胸片和上消化道造影明确诊断，均在电视胸腔镜下行食管气管瘘修补及食管吻合术。 结果 ２２ 例中，除１ 例中转开胸手术以外，其余病例均在胸腔镜下顺利完成手术；平均手术时间１４２． ３（１１８ ～１６５） ｍｉｎ，术后平均住院时间１５． ４１（８ ～２２ ） ｄ，第一次经口喂养时间平均３． ７８（３ ～５） ｄ，平均呼吸机通气时间２６． ５４（９ ～５２） ｈ。术后有８ 例因吻合口狭窄行胃镜下食管球囊扩张术； ２ 例出现吻合口瘘，１ 例予延长禁食时间，持续胃肠减压１ 周后好转，１ 例家属放弃治疗。除放弃治疗病例外，２１ 例获随访１ 个月至２ 年，随访中１ 例术后１ 个月出现食管气管瘘经再次手术治愈； ５ 例随访有吻合口狭窄，经１ ～４ 次球囊扩张后改善，现无明显吞咽困难； ２ 例有胃食管反流，现保守治疗中； １ 例气管稍狭窄，现观察中； 其余患儿生长发育良好。 结论 随着新生儿麻醉及手术技术的不断提高，胸腔镜下手术成为Ⅲ型食管闭锁合并气管食管瘘患儿首选的手术方案。
- Abstract:
- ObjectiveTo evaluate the value of thoracoscopic surgical repair of typeⅢesophageal atresia with tracheoesophageal fistula.MethodsThe 3trocar thoracoscopic procedures of esophageal anastomosis and fistula ligation were performed for 22 neonates from June 2015 to January 2018.There were 12 boys and 10 girls with a mean birth weight of 2.44±0.68(1.5~4.05）kg and a mean age of 4.27±1.81(2~9) days.All preoperative diagnoses were made based on radiology and esophageal radiological contrast.ResultsExcept for one case of conversion into open thoracotomy，the remainder underwent thoracoscopic surgical repair.The average operative duration was 142.34(118~165) min；the average time of first oral feeding 3.78(3~5) days；the average time of mechanical ventilation 26.54(9~52) hours and average duration of hospitalization 15.41(8~22) days.Eight cases developed anastomotic stricture requiring esophageal dilatation by gastroscopy.Recurrent fistula between esophagus and trachea developed in 2 cases and one patient was cured after 1 week of conservative treatment while another case gave up treatments.ConclusionDespite some existing limitations，thoracoscopic procedure is both safe and effective for typeⅢesophageal atresia with tracheoesophageal fistula.Better outcomes may be achieved with technique refinements.
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