胸腔镜手术治疗Ⅲ型食管闭锁的学习曲线  

Learning curve of thoracoscopic repair of Esophageal Atresia type Ⅲ

作　　者：刘钢[1] 黄柳明[1] 肖东[2] 王伟[1] 余梦楠[1] 覃胜灵[1] 邢国栋[1] 段炼[1] 张璟[1] 

机构地区：[1]北京军区总医院附属八一儿童医院,100700 [2]深圳市儿童医院

出　　处：《中华小儿外科杂志》2014年第8期582-585,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的：探讨胸腔镜手术治疗Ⅲ型先天性食管闭锁的学习曲线。方法回顾性分析了2010年9月至2013年7月期间经胸腔镜手术治疗的49例Ⅲ型食管闭锁患儿。按时间顺序分为2组,从手术时间、术后吻合口漏、吻合口狭窄、气管食管瘘复发发生率以及死亡和放弃治疗的数量进行比较。结果第一组1例因患儿体质量低,且食管两端距离过大转为开放式胃上提手术,其余48例均在胸腔镜下一期完成手术。两组手术时间分别为（192.71±33.133）min和（152.25±41.185）min,差异具有统计学意义（P〈0.05）。第一组死亡和放弃病例共5例,第二组死亡和放弃病例共1例。吻合口漏分别是6例和2例,气管食管瘘复发各1例,吻合口狭窄均为6例。第二组并发症的发生率较第一组明显减少。结论胸腔镜手术治疗Ⅲ型食管闭锁会有较长的学习曲线。经过若干例手术的经验积累,可望缩短手术时间和减少手术并发症。Objective To detective the learning curve of thoracoscopic repair of esophageal atresia with distal fistula（type Ⅲ）.Methods It is a retrospective analysis.49 cases of thoracoscopic repair of esophageal atresia tape Ⅲ were divided into two groups from September 2010 to July 2013. The outcomes of operating time,postoperative leakage,stenosis,recurrence of fistula,and death were compared.Results Conversion was necessary in one patient in group 1 for low-birth-weight（1 020 g）. There was a remarkable reduction of operating time（192.71±33.133 min vs 152.25±41.185 min）. The reduction of postoperative leakage or stenosis,recurrence of fistulae,and death were also shown as the results,although the difference was not significant due to the small number.Conclusions A relative longer learning curve should be processed in the thoracoscopic repair of esophageal atresia. However the operating time and complications will be reduced after the experience accumulation.

关 键 词：胸腔镜外科手术 食管闭锁 新生儿 

分 类 号：R726.5[医药卫生—儿科]