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):335-339.[doi:10.3760/cma.j.cn101785-202303014-007]
内应力延长技术治疗Ⅰ型食管闭锁
- Title:
- Clinical experience of elongating esophageal segments through Bougienage stretching technique for pure esophageal atresia
- Keywords:
- Esophageal Atresia; Surgical Procedures; Operative; Traction; Treatment Outcome
- 摘要:
- 目的 总结内应力延长技术治疗Ⅰ型食管闭锁的临床经验。方法 回顾性分析2015年1月至2018年12月上海交通大学医学院附属新华医院收治的32例Ⅰ型食管闭锁(esophageal atresia,EA)患儿临床资料,患儿均经评估后于手术前采取探条内应力技术延长食管近远端,观察内应力治疗后食管近远端距离变化、手术方式、术后并发症、生长发育等指标。结果 32例患儿初次评估食管近远端距离为(5.5±1.5)cm,术前行内应力延长(68.2±41.3)d,经内应力延长治疗后食管两盲端距离缩短至(-0.5±0.9)cm。32例最终均行食管重建手术,其中胸腔镜手术27例,开胸手术5例;16例行食管端端吻合术,13例行食管肌层环形切开食管延长术(Livaditis术),3例行近端食管盲袋翻转成形食管延长术(Flap术)。术后发生吻合口漏9例,吻合口狭窄30例,合并食管裂孔疝9例。平均随访52个月,发现8例存在营养不良、6例有发育迟缓、10例存在不同程度吞咽功能异常、7例口腔摄入功能轻度异常。结论 内应力延长技术在Ⅰ型食管闭锁患儿手术前应用,可有效延长近远端食管,达到利用自身食管组织重建食管连续性的目的。术后长期规范随访,早期处理并发症,有利于食道功能恢复,改善患儿远期生活质量。
- Abstract:
- Objective To summarize clinical experience of elongating esophageal segments through Bougienage stretching technique for pure esophageal atresia (EA) to achieve delayed primary anastomosis.Methods From January 2015 to December 2018,32 children of pure EA underwent Bougienage stretching technique before esophageal anastomosis.Results All of them survived postoperatively.Initial assessment revealed a proximal-distal length of (5.5±1.5)cm.After elongating for (68.2±41.3) days,the length shortened to (-0.5±0.9)cm.Reconstruction was performed by thoracoscopy (n=27) and thoracotomy (n=5).The postoperative complications included anastomotic leakage (n=9),stenosis (n=30),hiatal hernia (n=9),malnutrition (n=8) and developmental delay (n=6).Conclusion Bougienage stretching technique for pure EA is feasible with satisfactory clinical outcomes with autogenous esophagus for primary anastomosis.It is ideal for restoring esophageal function and enhancing quality-of-life of EA children.
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备注/Memo
收稿日期:2023-3-5。
基金项目:上海申康医院发展中心重大临床研究项目(SHDC2020CR2063B)
通讯作者:王俊,Email:jwangjl@126.com