先天性食道闭锁术后短期-中期疗效评定  

The Short to Long Term Surgical Outcomes of Congenital Esophageal Atresia

作　　者：张志波[1] 黄英[1] 王大佳[1] 苏朋俊[1] 王练英[1] 

机构地区：[1]中国医科大学附属盛京医院小儿外科,沈阳110004

出　　处：《中国医科大学学报》2010年第6期478-480,共3页Journal of China Medical University

摘　　要：目的回顾性分析我院诊治的先天性食道闭锁病例,总结诊断、治疗经验,分析影响预后因素,探讨术后短期-中期并发症及其处理经验、教训。方法随访并回顾性分析近3年来我院诊断、治疗、随访的先天性食道闭锁患儿,应用食道闭锁预后分级方法总结分析影响预后的主要因素。结果 2006年初~2009年10月临床资料完整的先天性食道闭锁病例48例（男33例,女15例）,平均体质量2667.86g（1700~3800g）;全部为Ⅰ期食道成形,主要术后并发症为肺炎、吻合口瘘（16%）、气管食管瘘、切口感染（11%）、迟发型气管食管瘘（7%）、食道狭窄（10%）,胃食管返流（67%）。死亡率为12.5%,主要死亡原因为严重肺内感染及复杂先天性心脏病。结论绝大多数食道闭锁患儿可以耐受Ⅰ期食道吻合术,术后短-中期预后良好;术前及术后影响预后及导致死亡的主要原因为复杂心血管畸形、误吸、肺内感染;主要中期并发症为胃食管返流、食道狭窄。Objective To explore the short to long term surgical outcomes and treatment experiences of esophageal atresia（EA）.Methods The clinical data of EA inpatients in our hospital from 2006 to 2009 were reviewed retrospectively.The birth weight,main associated anomalies,details of management,complications and outcomes were discussed.Main risk factors were evaluated with major prognostic classification systems.Results Totally 48 consecutive infants with EA were identified from 2006 to 2009,male 33（69%）,female 15（31%）.Mean birth weight was 2 668 g（range 1 700 g to 3 800 g）.All received primary operation.Complications included pneumonia,anastomotic leakage（16%）,tracheoesophageal fistula,incision sepsis（11%）,delayed tracheoesophageal fistula（7%）,stricture（10%）,and gastroesophageal reflux（GER）（67%）.Mortality was 12.5%,mainly due to severe pneumonia and complex cardiac anomalies.Conclusion Most patients with esophageal atresia could be cured after primary operation with excellent outcomes.The main factors for mortality were complex cardiac anomalies,aspiration and pneumonia.The main mid-term complications were GER and stricture.

关 键 词：食道闭锁 气管食管瘘 

分 类 号：R655.4[医药卫生—外科学]