食管盲袋翻转成形食管延长术治疗Ⅰ型食管闭锁的临床研究  

Clinical study to treat pure esophageal atresia with cystic pouch of proximal esophagus

作　　者：邬文杰[1] 潘伟华[1] 严文波[1] 谢伟[2] 龚一鸣[1] 王俊[1] Wu Wenjie;Pan Weihua;Yan Wenbo;Xie Wei;Gong Yiming;Wang Jun(Department of pediatric surgery,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine.Shanghai 200092,China;Department of Pediatric Intensive Care Unit,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine.Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院小儿外科,上海市200092 [2]上海交通大学医学院附属新华医院小儿重症医学科,上海市200092

出　　处：《临床小儿外科杂志》2018年第3期174-178,共5页Journal of Clinical Pediatric Surgery

基　　金：上海市小儿消化与营养重点实验室项目(17DZ2272000);上海申康医院发展中心科研项目(16CR3117B)

摘　　要：目的探讨利用近端食管盲端呈囊袋样扩张所可能产生的较为富裕的自身食管组织舌状襻翻转后管状成形以延长食管,从而达到一期食管重建的目的,进而提高Ⅰ型食管闭锁的疗效。方法回顾性分析本院2012年4月至2014年2月收治的3例近端食管盲袋呈囊袋状扩张的Ⅰ型食管闭锁患儿临床资料。经造影观察并多维度测量近端盲端食管的长度、宽度,预估可能翻转并形成食管延长的长度,评估一期食管重建的可能性。同时检索Pubmed、Embase、Web of Science数据库,检索词为"esophageal atresia/flap",对2016年12月前报道的采用近端食管盲袋翻转成形食管重建术治疗的先天性食管闭锁文献资料进行复习。结果 3例均一期完成食管重建,翻转后延长食管长度2.5~3 cm,术后发生吻合口漏3例,吻合口狭窄2例,分别经保守治疗和球囊扩张后痊愈出院。出院随访3~5年,无一例喂养困难或反复呼吸道感染。复习国外文献获得病例82例,其中型11例,Ⅲ型70例,Ⅳ型1例。结论近端食管盲袋翻转成形食管重建术是治疗近端食管呈囊袋状扩张的Ⅰ型先天性食管闭锁的有效方法,食管本身作为替代物优势明显,术后远期功能较好。Objective To summarize the clinical experience of upper esophageal flap repair for pure esophageal atresia with cystic pouch of proximal esophagus,and to improve the long-term esophageal function.Methods Retrospective analysis of 3 consecutive patients admitted into our department from April 2012 to February 2014 about the esophageal diameter,the distance between two esophageal pouches,the length of esophageal elongation and complications.More clinical cases were retrieved from the databases of Pubmed,Embase and Web of Science prior to December 2016.Results All infants survived postoperatively.The postoperative complications were anastomotic leakage(n=3),stenosis(n=2).The overall follow-up period was 3 to 5 years.Through literature retrieved,82 cases were included for this study.Conclusion Upper esophageal flap esophagoplasty is an effective treatment for pure EA with cystic pouch of proximal esophagus.As the esophageal prosthesis,autogenous esophagus has good functions.

关 键 词：食管闭锁 近端囊袋样扩张 舌状襻翻转 

分 类 号：R726.5[医药卫生—儿科]