管状胃代食管术在小儿食管外科中的应用效果  

Application of gastric tube esophagoplasty to complicated diseases of esophagus in children

作　　者：曾嘉航 刘威 梁建华 汪凤华 王会 唐决 Zeng Jiahang;Liu Wei;Liang Jianhua;Wang Fenghua;Wang Hui;Tang Jue(Department of Thoracic Surgery,Guangzhou Women and Children＇s Medical Center,Guangzhou 510120,China)

机构地区：[1]广州市妇女儿童医疗中心胸外科,510120

出　　处：《中华胃肠外科杂志》2018年第9期1025-1031,共7页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的总结管状胃代食管术在儿童多种复杂性食管疾病的应用经验及术后近一中期效果。方法采用描述性病例系列研究方法。入组标准：（1）食管烧伤段长段〉2CM、多段或广泛的食管瘢痕狭窄，并且烧伤后6个月左右。（2）食管肿瘤长径〉2cm，或考虑食管不能保留。（3）重度食管瘘，直径〉2cm或经过3次或以上修补仍复发。（4）长度〉2cm的食管软骨移位，或考虑切除病变食管后无法端端吻合。排除严重的心肺功能不全、有预后不良的胃原发性疾病、胃体积无法制作足够长的管状胃或家属不接受管状胃代食管术的患儿。根据上述标准，2010年3月至2017年6月期间，于广州市妇女儿童医疗中心胸外科接受管状胃代食管术的36例复杂性食管疾病患儿被纳入本研究，其中化学性食管烧伤导致复杂型食管瘢痕性狭窄27例，食管肿瘤5例，重度食管瘘3例，气管软骨移位症1例。27例食管烧伤患儿保留病变食管，行胸骨后隧道管状胃代食管术，其余9例患儿均行病变食管切除及经食管床管状胃代食管术。管状胃代食管构建方式如下：使用切割缝合器于幽门管上方，沿胃小弯侧裁剪胃体、贲门至胃底部，使管径与幽门管直径相当。评估患儿围手术情况，并参照美国疾病控制与预防中心（CDC）的CDC 2000儿童生长发育评估表（2～20岁）评估患儿术后近一中期生长发育情况。结果36例患儿均顺利完成手术．9例患儿术中切除病变食管，27保留原食管。术后机械辅助通气时间平均8（4-20）h。术后发生吻合口漏3例，1周后自愈；吻合口狭窄8例，经球囊扩张术后恢复正常饮食。随访6个月至7年，5例术后4-8月发现食管囊肿，均再行手术切除。1例患儿因婴儿型食管纤维肉瘤术后3周复发，家属放弃治疗，2周后死亡；其余35例患儿均存活。全组患儿营养和发育情况较术前改善，Objective To summarize the experience of applying gastric tube esophagoplasty for complicated diseases of esophagus in children and the short-middle-term efficacy. Methods A retrospective and observational case series study was performed. Inclusion criteria： （1） burn length of esophagus 〉 2 cm, multisegmental or extensive esophageal scar stenosis, and about 6 months after burn; （2） longitudinal diameter of esophageal tumor 〉 2 cm, or esophagus considered as impossible to reserve ; （3） Severe esophageal fistula with diameter 〉 2 cm, or relapse again after ≥ 3 times of repair ; （4） Tracheal cartilaginous esophageal heterotopia with a length of 〉2 cm or no end to end anastomosis after removal of the esophageal lesion. Exclusion criteria： patients with severe cardiopulmonary insufficiency, or poor prognosis of gastric primary disease; the gastric volume did not allow long enough gastric tube; the parents did not accept the surgery. According to above criteria, 36 children with complicated diseases of esophagus who underwent gastric tube esophagoplasty at Department of Thoracic Surgery, Guangzhou Women and Children＇s Medical Center from March 2010 to June 2017 were enrolled into this study. Among 36 children, 27 were with corrosive strictures of esophagus, 5 with esophageal tumor, 3 with severe esophageal fistula, and 1 with tracheal cartilaginous esophageal heterotopia. Above-mentioned 27 cases with cmTosive strictures of esophagus underwent gastric tube esophagoplasty via retrosternal route with preservation of the original esophagus. The other 9 cases underwent resection for esophageal lesion and gastric tube esophagoplasty via prevertebral route. The construction of gastric tube was as follows： the stomach was cut along the lesser curvature from pylorus to cardia and fundus of stomach with stapler, making the diameter of the gastric tube equal to pylorus. Operative time, intra-operative bleeding, time of mechanical ventilation, anastomotie leakage, anastomotic stricture were obser

关 键 词：儿童 管状胃 食管瘢痕性狭窄 食管瘘 食管肿瘤 

分 类 号：R735.1[医药卫生—肿瘤]