目的 探讨胸腔镜在Ⅲ型食管闭锁合并气管食管瘘修补术中的应用价值。方法 回顾性分析2015年6月至2018年1月采用胸腔镜手术治疗的22例Ⅲ型食管闭锁合并食管气管瘘患儿临床资料,其中男性12例,女性10例; 手术年龄2～9 d,平均手术年龄(4.27±1.81)d,体质量1.5～4.05 kg,平均体质量(2.44±0.68)kg。术前均经胸片和上消化道造影明确诊断,均在电视胸腔镜下行食管气管瘘修补及食管吻合术。结果 22例中,除1例中转开胸手术以外,其余病例均在胸腔镜下顺利完成手术; 平均手术时间142.3(118～165)min,术后平均住院时间15.41(8～22 )d,第一次经口喂养时间平均3.78(3～5)d,平均呼吸机通气时间26.54(9～52)h。术后有8例因吻合口狭窄行胃镜下食管球囊扩张术; 2例出现吻合口瘘,1例予延长禁食时间,持续胃肠减压1周后好转,1例家属放弃治疗。除放弃治疗病例外,21例获随访1个月至2年,随访中1例术后1个月出现食管气管瘘经再次手术治愈; 5例随访有吻合口狭窄,经1～4次球囊扩张后改善,现无明显吞咽困难; 2例有胃食管反流,现保守治疗中; 1例气管稍狭窄,现观察中; 其余患儿生长发育良好。结论 随着新生儿麻醉及手术技术的不断提高,胸腔镜下手术成为Ⅲ型食管闭锁合并气管食管瘘患儿首选的手术方案。
Objective To evaluate the value of thoracoscopic surgical repair of typeⅢesophageal atresia with tracheoesophageal fistula. Methods The 3-trocar thoracoscopic procedures of esophageal anastomosis and fistula ligation were performed for 22 neonates from June 2015 to January 2018.There were 12 boys and 10 girls with a mean birth weight of 2.44±0.68(1.5～4.05)kg and a mean age of 4.27±1.81(2～9)days.All preoperative diagnoses were made based on radiology and esophageal radiological contrast. Results Except for one case of conversion into open thoracotomy,the remainder underwent thoracoscopic surgical repair.The average operative duration was 142.34(118～165)min; the average time of first oral feeding 3.78(3～5)days; the average time of mechanical ventilation 26.54(9～52)hours and average duration of hospitalization 15.41(8～22)days.Eight cases developed anastomotic stricture requiring esophageal dilatation by gastroscopy.Recurrent fistula between esophagus and trachea developed in 2 cases and one patient was cured after 1 week of conservative treatment while another case gave up treatments. Conclusion Despite some existing limitations,thoracoscopic procedure is both safe and effective for typeⅢesophageal atresia with tracheoesophageal fistula.Better outcomes may be achieved with technique refinements.
