胸腔镜下先天性食管闭锁手术纠治的初步体会  

Thoracoscopic repair of congenital esophageal atresia in infants

作　　者：吴晔明[1] 严志龙[2] 洪莉[2] 胡明[2] 

机构地区：[1]上海交通大学医学院附属新华医院小儿外科,200092 [2]上海交通大学医学院附属上海儿童医学中心外科

出　　处：《中华小儿外科杂志》2009年第5期284-286,共3页Chinese Journal of Pediatric Surgery

基　　金：上海市科委生物医药重点科技攻关项目（054119570）、上海浦东新区科技发展基金项目（PKJ2005-52）

摘　　要：目的介绍胸腔镜下I期食管气管瘘管结扎、食管对端吻合治疗新生儿先天性Ⅲ型食管闭锁。方法收集6例本院2006年6月至2008年12月间经胸腔镜开展的新生儿食管闭锁手术病例，男4例，女2例，年龄2d～8周，影像学检查证实5例为ⅢB型食管闭锁，1例为ⅢA型食管闭锁。结果4例在镜下完成瘘管结扎切断、食管吻合手术，2例术中中转开胸。结论胸腔镜下新生儿ⅢB型食管闭锁瘘管结扎食管吻合是一种可取的手术途径，从已有报告及我们4例随访结果提示，镜下途径对患儿术中打击小，胸壁损伤轻，术后恢复快，微创效果明显，术中能否获得满意的暴露和食管两端的距离是影响手术的重要因素。Objective To introduce the thoracoscopic procedure of esophago-tracheal fistula ligation and one-stage esophageal anastomosis for neonatal esophageal atresia. Methods From Jun 2006 to Dec 2008, thoracoscopic procedures of fistula ligation and one-stage esophageal anastomosis were performed on 6 neonates with congenital esophageal atresia in our institutions. There were 4 boys and 2 girls, with the age from 2 days to 8 weeks. In all the cases, 5 were diagnosed as the esophageal atresia type ⅢB, while the other one as type ⅢA. Results Four cases underwent the thoracoscopic procedure of esophago-tracheal fistula ligation and one-stage esophageal anastomosis. Diverted thoracotorny was performed on 2 cases. Conclusions The thoracoscopic procedure of esophago-tracheal fistula ligation and one-stage esophageal anastomosis is an acceptable procedure for patients with type Ⅲ B esophageal atresia. From reported cases by others and 4 eases in our following-up, we conclude that less intra-operative threatening, fewer lesions of thoracic wall, earlier postoperative recovery and more minimal invasion can be gained from the thoracoscopic procedure. Satisfactory anatomic exposure and the distance between two ends of esophagus are the crucial factors which may affect the surgical effects.

关 键 词：食管闭锁 胸腔镜外科手术 症状 临床症状 

分 类 号：R686[医药卫生—骨科学]