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):318-322.[doi:10.3760/cma.j.cn101785-202111011-004]
先天性V型食管闭锁的临床特点及诊治经验
- Title:
- Clinical characteristics and treatments of congenital esophageal atresia type V
- Keywords:
- Esophageal Atresia; Diagnosis; Surgical Procedures; Operative; Treatment Outcome
- 摘要:
- 目的 探讨先天性V型食管闭锁的临床特点、诊治及预后情况。方法 回顾性分析2007年3月至2020年12月在首都医科大学附属北京儿童医院确诊并接受治疗的40例先天性V型食管闭锁患儿临床资料;其中男16例,女24例。收集并总结分析所有患儿临床表现及辅助检查结果、诊治经过及预后情况。结果 40例患儿中,27例(27/40,67.5%)于1岁内确诊。临床表现包括进食时呛咳、窒息、青紫(35/40,87.5%)以及反复肺部感染(25/40,62.5%)。40例均经食管造影(阳性率97.4%)和(或)纤维支气管镜(阳性率100.0%)检查确诊。34例瘘管位于第7颈椎至第2胸椎水平,经颈部入路行气管食管瘘修补术;6例瘘管位于第2至第4胸椎水平,采用右侧胸膜外入路。32例治愈;1例术后造影发现第二条瘘管;5例出现喉返神经损伤;1例出现吻合口漏,经保守治疗1个月后痊愈;1例死于呼吸衰竭。36例获随访,3例失访;3例气管食管瘘复发,经再次手术后治愈;1例出现食管狭窄,经扩张5次后治愈。其余患儿生长发育正常,无不适表现。结论 先天性V型食管闭锁临床症状不典型,易误诊,对可疑患儿行食管造影和纤维支气管镜检查有助于明确诊断。手术治疗效果良好,需警惕术后喉返神经损伤的可能。
- Abstract:
- Objective To explore the clinical characteristics,diagnosis and therapeutic principles of congenitalesophageal atresia type V.Methods Retrospective analysis was conducted for clinical data of children with congenital esophageal atresia type V from March 2007 to December 2020.There were 16 boys and 24 girls.The relevant clinical manifestations,auxiliary examination results,therapeutic principles and outcomes were recorded.Results Among them,27 (80.0%) were diagnosed within 1 year of age.Clinical manifestations included ingesting choking (87.5%) and recurrent pneumonitis (62.5%).A definite diagnosis was made by esophagography and/or fiberoptic bronchoscopy with a positive rate of 97.4% and 100.0% respectively.And 34 cases of fistula at C7-T2 were repaired through a cervical approach.Thoracic approach was selected for 6 cases of fistula at T2 -T4.Thirty-two cases were cured.Postoperative esophagography revealed a second fistula (n=1).Recurrent laryngeal nerve injury was present in 5 cases.One child of fistula repairing through a thoracic approach had anastomotic leak and was cured after 1-month conservative treatment.One child died from respiratory failure.Thirty-six cases were followed up and 3 cases became lost.Tracheoesophageal fistula recurred in 3 cases and was cured after reoperation.One case of esophageal stenosis was cured after 5 dilations.The remainders recovered well.Conclusion Clinical symptoms of congenital esophageal atresia type V are non-typical so that it may be easily misdiagnosed.Esophagography and fiberoptic bronchoscopy aid in a definite diagnosis.Surgery has an excellent efficacy.Postoperative recurrent laryngeal nerve injury should be avoided.
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备注/Memo
收稿日期:2021-11-11。
基金项目:首都临床特色诊疗技术研究与转化应用(Z211100002921062)
通讯作者:黄金狮,Email:jsdr2002@126.com