Wang Jun.Essentials of perioperative management of esophageal atresia[J].Journal of Clinical Pediatric Surgery,2023,22(04):313-317.[doi:10.3760/cma.j.cn101785-202304001-003]
先天性食管闭锁围手术期处理要点
- Title:
- Essentials of perioperative management of esophageal atresia
- Keywords:
- Esophageal Atresia; Surgical Procedures; Operative; Postoperative Complications; Prognosis
- 摘要:
- 先天性食管闭锁(esophageal atresia,EA)类型较多,显示出多样性和多变性,给临床处理带来一定困扰。临床上由于术前检查及评估欠精准而导致一期食管端端吻合手术失败或操作失误的现象时有发生,不仅给后续治疗带来困难,影响治疗效果,而且可以引起较多并发症和后遗症,给患儿生活质量带来不良影响。本文结合笔者多年临床经验,分析导致上述情况的可能原因,从围手术期处理要点入手,提出避免EA手术失败或操作失误的临床方法,以提高临床疗效,改善患儿预后。
- Abstract:
- Too many types of congenital esophageal atresia with a great diversity and variability bring dilemmas to clinical management.In clinical cases of first-stage end-to-end esophageal anastomosis,operative failure and error occur frequently due to inaccurate preoperative examinations and evaluations.Subsequent treatment becomes extremely difficult so that therapeutic efficacy is poor.Subsequent complications and sequelae adversely affect the quality of life.Based upon an etiological analysis of actual clinical cases,this review proposed practical and feasible clinical measures of avoid surgical failures and operative errors to improve the therapeutic outcomes of esophageal atresia.
参考文献/References:
[1] van der Zee DC,Bagolan P,Faure C,et al.Position paper of INoEA working group on long-gap esophageal atresia:for better care[J].Front Pediatr,2017,5:63.DOI:10.3389/fped.2017.00063.
[2] van Lennep M,Singendonk MMJ,Dall’Oglio L,et al.Oesophageal atresia[J].Nat Rev Dis Primers,2019,5(1):26.DOI:10.1038/s41572-019-0077-0.
[3] Foker JE,Linden BC,Boyle EM Jr,et al.Development of a true primary repair for the full spectrum of esophageal atresia[J].Ann Surg,1997,226(4):533-543.DOI:10.1097/00000658-199710000-00014.
[4] Gross ER,Reichstein A,Gander JW,et al.The role of fiberoptic endoscopy in the evaluation and management of long gap isolated esophageal atresia[J].Pediatr Surg Int,2010,26(12):1223-1227.DOI:10.1007/s00383-010-2731-1.
[5] Brown AK,Tam PK.Measurement of gap length in esophageal atresia:a simple predictor of outcome[J].J Am Coll Surg,1996,182(1):41-45.
[6] Holcomb GW 3rd.Thoracoscopic surgery for esophageal atresia[J].Pediatr Surg Int,2017,33(4):475-481.DOI:10.1007/s00383-016-4049-0.
[7] Taghavi K,Stringer MD.Preoperative laryngotracheobronchoscopy in infants with esophageal atresia:why is it not routine?[J].Pediatr Surg Int,2018,34(1):3-7.DOI:10.1007/s00383-017-4194-0.
[8] Garge S,Rao KLN,Bawa M.The role of preoperative CT scan in patients with tracheoesophageal fistula:a review[J].J Pediatr Surg,2013,48(9):1966-1971.DOI:10.1016/j.jpedsurg.2013.06.010.
[9] Higano NS,Bates AJ,Tkach JA,et al.Pre- and post-operative visualization of neonatal esophageal atresia/tracheoesophageal fistula via magnetic resonance imaging[J].J Pediatr Surg Case Rep,2018,29:5-8.DOI:10.1016/j.epsc.2017.10.001.
[10] Puri P,Blake N,O’Donnell B,et al.Delayed primary anastomosis following spontaneous growth of esophageal segments in esophageal atresia[J].J Pediatr Surg,1981,16(2):180-183.DOI:10.1016/S0022-3468(81)80347-8.
[11] Puri P,Ninan GK,Blake NS,et al.Delayed primary anastomosis for esophageal atresia:18 months’ to 11 years’ follow-up[J].J Pediatr Surg,1992,27(8):1127-1130.DOI:10.1016/0022-3468(92)90573-p.
[12] Feng XY,Thomé U,Stepan H,et al.Surgical treatment of esophageal atresia with lower tracheoesophageal fistula in an extremely preterm infant (510 g,25+ 5 weeks):a case report[J].J Med Case Rep,2021,15(1):361.DOI:10.1186/s13256-021-02951-x.
[13] Zani A,Cobellis G,Wolinska J,et al.Preservation of native esophagus in infants with pure esophageal atresia has good long-term outcomes despite significant postoperative morbidity[J].Pediatr Surg Int,2016,32(2):113-117.DOI:10.1007/s00383-015-3821-x.
[14] Zani A,Eaton S,Hoellwarth ME,et al.International survey on the management of esophageal atresia[J].Eur J Pediatr Surg,2014,24(1):3-8.DOI:10.1055/s-0033-1350058.
[15] Friedmacher F,Puri P.Delayed primary anastomosis for management of long-gap esophageal atresia:a meta-analysis of complications and long-term outcome[J].Pediatr Surg Int,2012,28(9):899-906.DOI:10.1007/s00383-012-3142-2.
[16] Lee HQ,Hawley A,Doak J,et al.Long-gap oesophageal atresia:comparison of delayed primary anastomosis and oesophageal replacement with gastric tube[J].J Pediatr Surg,2014,49(12):1762-1766.DOI:10.1016/j.jpedsurg.2014.09.017.
[17] Brennan K,Cullis P,Yardley I,et al.Oesophageal lengthening by traction in oesophageal atresia:the UK experience[J].J Pediatr Surg,2022,57(2):187-191.DOI:10.1016/j.jpedsurg.2021.10.039.
[18] Puri P,Friedmacher F.Delayed primary anastomosis in the management of long-gap esophageal atresia[M]//Till H,Thomson M,Foker JE,et al.Esophageal and Gastric Disorders in Infancy and Childhood.Berlin:Springer,2017:221-227.DOI:10.1007/978-3-642-11202-7_21.
[19] Bogusz B,Patkowski D,Gerus S,et al.Staged thoracoscopic repair of long-gap esophageal atresia without temporary gastrostomy[J].J Laparoendosc Adv Surg Tech A,2018,28(12):1510-1512.DOI:10.1089/lap.2018.0188.
[20] Sun SN,Pan WH,Wu WJ,et al.Elongation of esophageal segments by bougienage stretching technique for long gap esophageal atresia to achieve delayed primary anastomosis by thoracotomy or thoracoscopic repair:a first experience from China[J].J Pediatr Surg,2018,53(8):1584-1587.DOI:10.1016/j.jpedsurg.2017.12.009.
相似文献/References:
[1]杜朝峻,丁力,胡英超,等.手术治疗婴幼儿法洛四联症83例[J].临床小儿外科杂志,2010,9(06):413.
DU Chao jun,DING Li,HU Ying chao,et al.Surgical treatment of Tetralogy of Fallot in infancy: Experiences of 83 cases.[J].Journal of Clinical Pediatric Surgery,2010,9(04):413.
[2]李勇,尹强,周小渔,等.术中胆道造影在先天性胆总管囊肿手术中的应用[J].临床小儿外科杂志,2010,9(06):430.
LI Yong,YIN Qiang,ZHOU Xiao yu,et al.The clinic application experience on intraoperative cholangiography in pediatric surgery.[J].Journal of Clinical Pediatric Surgery,2010,9(04):430.
[3]许芝林,王强,李琰,等.乙状结肠冗长症的术式选择探讨[J].临床小儿外科杂志,2010,9(06):432.
XU Zhi lin,WANG Qiang,LI Yan,et al.Initiatory exploration of the standard of surgical treatment methods for Dolichosigmoid.[J].Journal of Clinical Pediatric Surgery,2010,9(04):432.
[4]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[5]胡明,施诚仁,严志龙.脐环小切口治疗婴幼儿腹盆腔疾病的探讨[J].临床小儿外科杂志,2010,9(06):471.
[6]丁勇,魏华,孔燕,等.横裁包皮岛状皮瓣法在尿道下裂治疗中的应用[J].临床小儿外科杂志,2010,9(06):474.
[7]江峰赵阳孙莲萍金惠明马杰.婴幼儿阻塞性脑积水两种手术方式的疗效比较[J].临床小儿外科杂志,2011,10(01):0.
JIANG Feng,ZHAO Yang,SUN Liang ping,et al.Endoscopic third ventricul ostomy versus ventricul operitoneal shunt:clinical study of obstructive hydro cephalus in infants.[J].Journal of Clinical Pediatric Surgery,2011,10(04):0.
[8]王伟程少文彭磊林忠勤张伟陈庆玉寇冬权.弹性髓内钉在儿童肱骨骨折中的应用[J].临床小儿外科杂志,2011,10(01):0.
WANG Wei,CHENG Shaowen,PENG Lei,et al.Application of elastic intramedullary nailing in pediatric humeral fractures.[J].Journal of Clinical Pediatric Surgery,2011,10(04):0.
[9]景登攀张根领孙蔓丽.改良Snodgrass术治疗尿道下裂疗效观察[J].临床小儿外科杂志,2011,10(01):0.
[10]孔赤寰 马继东 赵英敏 李 龙.球囊扩张治疗先天性食管闭锁术后食管狭窄的时机选择[J].临床小儿外科杂志,2010,9(04):0.
[11]周佳亮,葛午平,田松,等.某中心近十五年间先天性食管闭锁的诊治与并发症分析[J].临床小儿外科杂志,2018,17(04):282.
Zhou Jialiang,Ge Wuping,Tian Song,et al.Treatment outcomes and complications of congenital esophageal atresia: a singlecenter report of 15 years.[J].Journal of Clinical Pediatric Surgery,2018,17(04):282.
[12]周崇高,李波,邹婵娟,等.胸腔镜下一期手术治疗食管闭锁合并气管软化的短期疗效[J].临床小儿外科杂志,2022,21(11):1062.[doi:10.3760/cma.j.cn101785-202204049-012]
Zhou Chonggao,Li Bo,Zou Chanjuan,et al.Short-term outcomes of one-stage thoracoscopy for esophageal atresia plus tracheomalacia[J].Journal of Clinical Pediatric Surgery,2022,21(04):1062.[doi:10.3760/cma.j.cn101785-202204049-012]
[13]汪健.食管闭锁的病因研究及临床关注热点[J].临床小儿外科杂志,2023,22(04):307.[doi:10.3760/cma.j.cn101785-202303037-002]
Wang Jian.Etiology and clinical research hotspots of esophageal atresia[J].Journal of Clinical Pediatric Surgery,2023,22(04):307.[doi:10.3760/cma.j.cn101785-202303037-002]
[14]王沛则,赵勇,杨深,等.先天性V型食管闭锁的临床特点及诊治经验[J].临床小儿外科杂志,2023,22(04):318.[doi:10.3760/cma.j.cn101785-202111011-004]
Wang Peize,Zhao Yong,Yang Shen,et al.Clinical characteristics and treatments of congenital esophageal atresia type V[J].Journal of Clinical Pediatric Surgery,2023,22(04):318.[doi:10.3760/cma.j.cn101785-202111011-004]
[15]原丽科,肖尚杰,许露,等.先天性食管闭锁的临床特征及预后影响因素分析[J].临床小儿外科杂志,2023,22(04):323.[doi:10.3760/cma.j.cn101785-202107026-005]
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.[doi:10.3760/cma.j.cn101785-202107026-005]
[16]李佳雯,李颖,牛文元,等.Ⅲ型先天性食管闭锁手术后吻合口漏的危险因素分析及风险模型建立[J].临床小儿外科杂志,2023,22(04):329.[doi:10.3760/cma.j.cn101785-202212008-006]
Li Jiawen,Li Ying,Niu Wenyuan,et al.Risk factors related to anastomotic leakage after operation for type Ⅲ congenital esophageal atresia and risk modeling[J].Journal of Clinical Pediatric Surgery,2023,22(04):329.[doi:10.3760/cma.j.cn101785-202212008-006]
[17]邬文杰,林阳文,龚一鸣,等.内应力延长技术治疗Ⅰ型食管闭锁[J].临床小儿外科杂志,2023,22(04):335.[doi:10.3760/cma.j.cn101785-202303014-007]
Wu Wenjie,Lin Yangwen,Gong Yiming,et al.Clinical experience of elongating esophageal segments through Bougienage stretching technique for pure esophageal atresia[J].Journal of Clinical Pediatric Surgery,2023,22(04):335.[doi:10.3760/cma.j.cn101785-202303014-007]
[18]王俊杰,何秋明,钟微,等.H型先天性食管气管瘘的程序化诊治[J].临床小儿外科杂志,2023,22(04):340.[doi:10.3760/cma.j.cn101785-202303015-008]
Wang Junjie,He Qiuming,Zhong Wei,et al.Programmed management of H-type congenital tracheoesophageal fistula[J].Journal of Clinical Pediatric Surgery,2023,22(04):340.[doi:10.3760/cma.j.cn101785-202303015-008]
[19]权董文,田永仓,刘仕琪.长段型食管闭锁磁力吻合治疗现状及展望[J].临床小儿外科杂志,2024,(03):284.[doi:10.3760/cma.j.cn101785-202306035-016]
Quan Dongwen,Tian Yongcang,Liu Shiqi.Current status and future prospects of using magnamosis remedy long-gap esophageal atresia through a mini-invasive approach[J].Journal of Clinical Pediatric Surgery,2024,(04):284.[doi:10.3760/cma.j.cn101785-202306035-016]
备注/Memo
收稿日期:2023-4-1。
基金项目:上海申康医院发展中心第二轮临床三年行动计划重大临床研究项目(SHDC2020CR2063B)
通讯作者:王俊,Email:wangjun@xinhuamed.com.cn