先天性食管闭锁手术后并发症及处理

首都医科大学附属北京儿童医院新生儿外科(北京市,100045)

食管闭锁; 手术后并发症; 吻合口

Analysis and management of short-term postoperative complications after esophageal atresia repair.
Li Yingzi,Huang Jinshi,Du Jingbin,Zhang Yanan,Guo Weihong,Hou Dawei,Chen Yongwei.

Department of Neonatal Surgery,Affiliated Beijing Children's Hospital,Capital Medical University,Beijing 100045,China. Corresponding author:Chen Yongwei,Email:yongwei1964@126.com

Esophageal Atresia; Postoperative Complications; Stomas

DOI: 10.3969/j.issn.1671— 6353.2018.07.010

备注

目的 分析先天性食管闭锁的临床治疗效果,探讨先天性食管闭锁患儿术后常见并发症的发生率,为临床治疗方案的选择提供参考。方法 回顾性分析2007年1月至2016年12月本院采取手术治疗并存活的303例先天性食管闭锁患儿临床资料。对其中Ⅲ型食管闭锁患儿按照所采取的手术方式(开放性手术或腔镜手术)进行分组后比较分析。结果 303例中,Gross分型Ⅰ型10例,Ⅱ型4例,Ⅲ型261例,Ⅳ型9例,Ⅴ型19例; 术后出现吻合口漏64例,吻合口狭窄87例。261例Ⅲ型病例中,实施开放性手术84例,腔镜手术177例; 术后出现食管吻合口漏56例(开放手术组39例,腔镜手术组17例); 食管吻合口狭窄72例(开放手术组8例,腔镜手术组64例); 气管食管瘘复发17例(开放手术组2例,腔镜手术组15例); 经卡方检验,Ⅲ型先天性食管闭锁患儿两种术式之间术后吻合口漏及吻合口狭窄的发生率差异有统计学意义(均有P<0.05)。结论 先天性食管闭锁手术后常见并发症为吻合口漏及吻合口狭窄,对于吻合口漏可采取保守治疗,吻合口狭窄多数经食管扩张可以缓解。Ⅲ型食管闭锁胸腔镜手术后吻合口漏的发生率较开胸手术低,但吻合口狭窄的发生率较高。气管食管瘘复发罕见的术后并发症,经再次手术修补可治愈。
Objective To explore the mobility and mortality of anastomotic stricture(AS)and anastomotic leakage(AL)after esophageal atresia(EA)repair. Methods A retrospective study was conducted for the clinical data of 303 EA patients underwent esophageal anastomosis between January 2007 and December 2016.Type Ⅲ patients were divided into two groups to evaluate the temporal differences between open surgery(OP)and thoracoscopic repair(TR). Results Gross types of EA were Ⅰ(n=10),Ⅱ(n=4),Ⅲ(n=261),Ⅳ(n=9)and Ⅴ(n=19).There were OR(n=84)and TR(n=177)in type Ⅲ series.For 72 AS cases,OP(n=8)and TR(n=64); for 56 AL cases,OP(n=35)and TR(n=17); for 17 cases of recurrent fistula,OP(n=2)and TR(n=15).By chi-square test,the differences were statistically significant for anastomotic stricture and leakage between OP and TR.No statistical inter-group difference existed in recurrent fistula. Conclusion Anastomotic leakage and structure are two common postoperative complications after EA repair.AL heals spontaneously after conservative measures.Stricture requires subsequent esophageal dilatations.There is a higher morbidity of AS but a lower rate of AL in TR series.Recurrent and yet infrequent TEF requires reoperation by thoracotomy or thoracoscopy.