Li Ming,Zhou Chonggao,Xiao Yong,et al.Clinical characteristics, diagnosis and treatment of type-Ⅲ Esophageal Atresia complicated by gastric perforation[J].Journal of Clinical Pediatric Surgery,2021,20(12):1132-1136.[doi:10.12260/lcxewkzz.2021.12.006]
Ⅲ型食管闭锁并发胃穿孔的临床特点及诊治
- Title:
- Clinical characteristics, diagnosis and treatment of type-Ⅲ Esophageal Atresia complicated by gastric perforation
- 分类号:
- R571;R573
- 摘要:
- 目的 总结Ⅲ型食管闭锁并发胃穿孔的临床特点、诊治及预后。方法 回顾性分析2007年1月至2021年1月湖南省儿童医院收治的623例先天性食管闭锁患者中7例术前并发胃穿孔患者资料，均为Ⅲ型食管闭锁，其中男性6例，女性1例，入院时年龄1~3 d，平均（1.5±0.7） d；临床表现为呼吸困难3例，气促发绀3例，呕吐1例。均经食管造影检查确诊为Ⅲ型食管闭锁。入院后因突发腹胀、呼吸困难加重，腹部X线片提示气腹，考虑胃穿孔。经腹腔穿刺抽吸处理后腹胀缓解，呼吸困难好转。4例行急诊手术，其中1例采取开胸气管食管瘘结扎+食管端端吻合+开腹坏死胃壁切除胃修补术，3例采取胸腔镜下气管食管瘘结扎+食管端端吻合+开腹胃穿孔修补术；3例放弃手术。结果 4例手术患者均痊愈出院，随访1~2年，平均随访（1.5±0.3）年，有1例出现吻合口狭窄，经球囊扩张治疗后痊愈；无一例并发吻合瘘或气管食管瘘复发；4例经口喂养均正常，生长发育良好，体重增长较好。3例放弃手术治疗患者死亡。结论 Ⅲ型食管闭锁并发胃穿孔病情进展快，诊治难度大。腹腔穿刺抽吸是有效的紧急处理方式。胸腔镜下气管食管瘘结扎、食道端端吻合术及开腹胃壁修补术是可行的。
- Abstract:
- Objective To study the clinical characteristics, diagnosis and treatment and prognosis of type-Ⅲ esophageal atresia (EA) complicated by gastric perforation.Methods From January 2007 to January 2021, a total of 7 children with type-Ⅲ EA complicated by gastric perforation were recruited, and their managements and prognosis were analyzed based on follow-up data.6 boys and 1 girl with an age range from 1 to 3 days were included.The clinical symptoms included dyspnea (n=3), polypne and cyanosis (n=3), vomiting (n=1).Patients were transferred to our hospital because of suspected diagnosis of EA, and 6 of them were intubated and mechanically ventilated preoperatively.The diagnosis of type-Ⅲ EA was confirmed by esophagography.Patients had a sudden abdominal distention and aggravated respiratory distress, and their general condition deteriorated.Pneumoperitoneum detected by X-ray scan was thought to be caused by air-related gastric perforation through the fistula.As an emergency measure, a local anesthetic abdominal puncture was performed at the bedside, and all patients showed improvement in respiratory distress and oxygen saturation.4 children received emergency surgery, and 3 of them underwent thoracoscopic ligation of tracheoesophageal fistula and oesophageal anastomosis followed by laparotomy and closure of the perforation of the stomach, the other one received thoracotomy with ligation of tracheoesophageal fistula and oesophageal anastomosis followed by laparotomy and closure of the perforation of the stomach.Results No anastomosis leakage occurred after surgery, and all 4 children recovered well and were discharged.During 1-2 years’ follow-up, 1 children showed anastomosis stenosis and was cured with the treatment of balloon dilation, and no recurrence of tracheoesophageal fistula was observed.All children are fed orally with good growth and development and satisfied weight gain.Conclusion The incidence of type-Ⅲ EA complicated by gastric perforation is low, but the patient’s general condition deteriorates rapidly and the diagnosis and treatment are always difficult.The prognosis of type-Ⅲ EA complicated by gastric perforation is good if patients received effective treatment, abdominal puncture and aspiration are effective emergency treatment, and it is feasible to perform thoracoscopic ligation of tracheoesophageal fistula and oesophageal anastomosis followed by laparotomy and closure of the perforation of the stomach.
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备注/Memo
收稿日期:2021-03-26。
基金项目:湖南省出生缺陷协调防治科技重大专项（编号：2019SK1010）
通讯作者:周崇高,Email:zhouchonggao@sina.com