Xi Linyun,Wu Chun,Pan Zhengxia,et al.Analysis of risk factors of complications in type Ⅲ congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,2019,18(06):462-466.[doi:10.3969/j.issn.1671-6353.2019.06.006]
Ⅲ型先天性食管闭锁手术后并发症的危险因素分析
- Title:
- Analysis of risk factors of complications in type Ⅲ congenital esophageal atresia
- Keywords:
- Esophageal Atresia/SU; Esophageal Atresia/CO; Postoperative Complications; Esophageal Atresia/ET
- 分类号:
- R726.1;R655.4;R571+.1
- 摘要:
- 目的 探讨Ⅲ型先天性食管闭锁手术后吻合口漏及吻合口狭窄的危险因素及预防措施。方法 收集重庆医科大学附属儿童医院胸心外科 2013年1月1日至2014 年12月31日确诊为Ⅲ型先天性食管闭锁并行手术治疗的患儿64例，所有患儿均行Ⅰ期气管食管瘘切断、食管端端吻合重建术。其中ⅢA型21例，ⅢB型43例。分析ⅢA及ⅢB型中出现吻合口漏及吻合口狭窄与出生体重、胎龄、伴发畸形、肺部感染、低蛋白血症之间的关系。结果 ⅢA型组中出现吻合口漏7例，再狭窄11例。无论是在ⅢA型还是ⅢB型患儿中，早产儿中吻合口漏或者狭窄的发生率与足月儿比较差异无统计学意义（P>0.05）；低出生体重儿吻合口漏或者狭窄的发生率与正常体重儿比较差异无统计学意义（P>0.05）。伴发畸形患儿吻合口漏或者狭窄的发生率与未伴发畸形患儿比较差异无统计学意义（P>0.05）。肺部感染患儿吻合口漏或者狭窄的发生率与未出现肺部感染患儿比较差异无统计学意义（P>0.05）；而低蛋白血症患儿吻合口漏或者狭窄的发生率与未发生低蛋白血症患儿比较差异有统计学意义（P < 0.05）。结论 伴发畸形、出生体重、胎龄均不是吻合口漏及狭窄的危险因素，低蛋白血症为吻合口漏及狭窄的危险因素，而吻合口漏又是吻合口狭窄的危险因素。
- Abstract:
- Objective To explore the complications and influencing factors of type Ⅲ congenital esophageal atresia (CEA). Methods A retrospective analysis was performed for 64 cases of concurrent Ⅲ CEA from January 1,2013 to December 31,2014.The clinical types were ⅢA (n=21) and ⅢB (n=43).All of them underwent resection of tracheoesophageal fistula and anastomosis of esophagus.The gestational age of children was 33.3 to 41.6 weeks and their birth weights were between 2200 to 4000 grams.There were also other congenital malformations (n=39),pneumonia (n=33) and hypoproteinemia (n=20).The relationship of type ⅢA/B was analyzed between anastomotic leak,esophageal stricture and gestational age,birth weight,associated congenital malformations,pneumonia and hypoproteinemia.Results In type Ⅲ A group,there were anastomotic leak (n=7) and esophageal stricture (n=11).No significant difference of anastomotic leak or esophageal stricture existed in estational age,birth weight or associated congenital malformations.However,there was significant difference in hypoproteinemia.In type ⅢB group,there were anastomotic leak (n=3) and esophageal stricture (n=3).Significant difference of anastomotic leak or esophageal stricture was absent in terms of gestational age,birth weight and associated congenital malformations.However,there was significant difference in hypoproteinemia. Conclusion Gestational age,birth weight and associated congenital malformations are not risk factors of anastomotic leak or esophageal stricture.Anastomotic tension and hypoproteinemia are risk factors.Moreover,anastomotic leak is a risk factor of esophageal stricture.
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备注/Memo
收稿日期:2018-09-05。
基金项目:国家临床重点专科建设项目（国卫办医函[2013]544）
通讯作者:吴春,Email:wuchun007@sina.com