临床小儿外科杂志

目的探讨食管内张力延长技术对Ⅰ型食管闭锁患儿的疗效和临床应用价值。方法回顾性分析2014年6月至2016年9月本院应用食管内张力延长技术辅助治疗的6例Ⅰ型食管闭锁患儿临床资料,男3例,女3例,出生后行胃造瘘手术并完善食管造影及支气管镜检查诊断Ⅰ型食管闭锁,检查3月龄以上患儿上、下食管盲端相距仍大于4个椎体间隙,分别于上、下两盲端食管内行张力延长。结果 6例患儿分别给予36 d、42 d、69 d、28 d、 55 d、64 d食管内张力延长后顺利完成胸腔镜下食管端端吻合,术后吻合口瘘1例,经保守治疗17 d愈合,全部患儿治愈出院。随访2个月至1年11个月,吻合口狭窄3例,行1～5次食管扩张。结论食管内张力延长技术在Ⅰ型食管闭锁的治疗中疗效确切,能避免食管吻合前胸腔内手术操作,达到依靠本身食管完成食管端端吻合的目的 ,值得进一步推广应用。

Objective To explore the application and efficacy of esophageal tension-extension technique in children with type I congenital esophageal atresia(CEA). Methods Six cases of type I CEA were recruited from June 2014 and September 201 There were 3 boys and 3 girls. Percutaneous endoscopic gastrostomy was performed on each patient after birth. Type I CEA was diagnosed through esophagogram and bronchoscopy. Since the distance between upper and lower esophageal ends remained wider than 4 centrums at Month 3 post-birth,thoracoscopic tension-extension treatment was performed on the upper and lower esophageal ends. Results Thoracoscopic esophageal end-to-end anastomosis was performed at Day 36,42,69,28,55 and 64 days post-treatment. One case of stoma fistula was cured through conservative measures at Day All children healed and left hospital. At Month 2～23,3 cases of anastomotic stenosis underwent 1 to 5 sessions of esophagectasis. Conclusion The above tension-extension technique is efficacious for type I CEA. It avoids thoracic surgery and achieves the anastomosis of esophagus ends. A wider popularization is recommended.

引言
1 材料与方法
2 结果
3 讨论

图1 操作示意图<br/>Fig.1 Operative schematic diagram

图1 操作示意图
Fig.1 Operative schematic diagram

图2 食管内张力延长前食管造影; 图3张力延长28 d透视下影像; 图4张力延长42 d透视下影像; 图5张力延长 56 d透视下影像; 图6张力延长64 d透视下影像<br/>Fig.2 Esophageal imaging before tension extensionl; Fig. 3 Tension extension at Day 28 under fluoroscopic imaging; Fig. 4 Tension extension at Day 42 under fluoroscopic imaging; Fig.5 Tension extension at Day 56 under fluoroscopic imaging; Fig. 6 Tension extension at Day 64 under fluoroscopic imaging

图2 食管内张力延长前食管造影; 图3张力延长28 d透视下影像; 图4张力延长42 d透视下影像; 图5张力延长 56 d透视下影像; 图6张力延长64 d透视下影像
Fig.2 Esophageal imaging before tension extensionl; Fig. 3 Tension extension at Day 28 under fluoroscopic imaging; Fig. 4 Tension extension at Day 42 under fluoroscopic imaging; Fig.5 Tension extension at Day 56 under fluoroscopic imaging; Fig. 6 Tension extension at Day 64 under fluoroscopic imaging

表1 6例患儿临床资料<br/>Table 1 Clinical profiles of six children

表1 6例患儿临床资料
Table 1 Clinical profiles of six children

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备注

引言

1 材料与方法

2 结果

3 讨论

期刊信息

备注

引言

1 材料与方法

2 结 果

3 讨 论

期刊信息

2 结果

3 讨论