胸膜外径路和胸腔镜两种手术方法治疗Ⅲ型先天性食管闭锁的临床疗效  

Clinical Efficacy of External Pleural Approach and Video-assisted Thoracoscopic Surgery in the Treatment of Type Ⅲ Esophageal Atresia

作　　者：曹辛[1] 吴骏[1] 洪伟[1] 张鸿[1] 王若谷[1] 陈健 罗忠明 高云鹏[1] CAO Xin;WU Jun;HONG Wei;ZHANG Hong;WANG Ruo-gu;CHEN Jian;LUO Zhong-ming;GAO Yun-peng(Dept.of Cardiothoracic Surgery,The Children's Hospital,Kunming Medical Universit,Kunming Yunnan 650228,China)

机构地区：[1]昆明医科大学附属儿童医院心胸外科,云南昆明650228

出　　处：《昆明医科大学学报》2019年第1期65-69,共5页Journal of Kunming Medical University

基　　金：云南省卫生计生委内设项目基金资助项目(2017NS115)

摘　　要：目的探讨治疗III型先天性食管闭锁(CEA) 2种手术方法的临床疗效。方法以2016年1月至2018年7月昆明市儿童医院收治63例III型先天性食管闭锁患儿为研究对象,根据手术方法分为胸膜外径路组和胸腔镜组。采用回顾性分析方法,对2组患儿(胸膜外径路组35例,胸腔镜组28例)的一般资料、围手术期情况和治疗结果进行分析,总结III型CEA的手术疗效。结果 (1) 2组患儿性别、早产儿数、合并畸形数、III型食道闭锁亚型比较,差异无统计学意义(P>0.05)。2组患儿手术日龄、出生体重比较,P <0.05,差异有统计学意义;(2) 2组患儿住院天数经比较(P>0.05),差异无统计学意义。2组患儿手术时间、术后呼吸机使用时间经比较,差异无统计学意义(P <0.05);(3) 2组患儿术后死亡数、术后吻合口漏数、术后吻合口狭窄数、术后气管食管瘘复发数比较,结果 P>0.05,差异无统计学意义。胸膜外径路组35例1期完成食管气管瘘修补+食管吻合术;1例同期行左侧开胸,动脉导管结扎术;1例同期行胃空肠吻合、胃造瘘术。胸腔镜组28例均一期完成食管气管瘘修补+食管吻合术。结论胸膜外径路手术作为治疗先天性食管闭锁的一种手术方法具有以下优势:(1)对设备、麻醉要求相对低;(2)明确诊断的低日龄、低出生体重患儿无需特殊准备就能尽早手术;(3)合并其它危及生命的畸形可以同期矫治。新生儿胸腔镜手术方法是一种新兴的手术方法,胸腔镜手术在手术日龄、出生体重、手术时间及术后呼吸机使用时间不占优势,考虑与胸腔镜技术在昆明医科大学附属儿童医院开展时间不长有关。资料显示2种手术方法在手术疗效方面基本一致,但远期临床疗效仍需进一步随访。Objective To evaluate the clinical efficacy between the two surgical Methods(external pleural approach and video-assisted thoracoscipic surgery)for the treatment of typeⅢcongenital esophageal atresia(CEA).Methods From January 2016 to July 2018,63 children with typeⅢcongenital esophageal atresia were admitted in the Children's Hospital,Kunming Medical University.According to the surgical Methods,they were divided into external pleural approachgroup(EPA group)and thoracoscopic group(VATS group).The retrospective analysis method was used to analyze the general data,while the perioperative conditions,the treatment Results of the two groups(35 patients in the EPA group and 28 in the VATS group),and the clinical effects of the typeⅢCEA were summarized.Result(1)Gender,premature infants,combined malformations,and typeⅢesophageal atresia subtypes were compared between the two groups(P >0.05),the difference ces were not statistically significant.Age of surgery and birth weight of the two groups were compared(P<0.05),the differences were statistically significant.(2)The hospitalization days of the two groups were compared(P >0.05),the differences were not statistically significant.The operation time and postoperative ventilator use time of the two groups were compared(P<0.05),the differences were statistically significant.(3)The number of postoperative deaths,postoperative anastomotic leakage,postoperative anastomotic stenosis,and postoperative tracheal esophageal fistula recurrence were compared between the two groups.P >0.05 in all the comparisions,and the differences were not statistically significant.35 cases of pleural outer diameter group completed tracheoesophageal fistula repairingand esophageal anastomosis in one stage;1 case underwent left thoracotomy and arterial catheter ligation at the same time;1 case underwent gastrojejunostomy and gastrostomy.Twenty-eight patients in the thoracoscopic group completed to surgery in one stage too.Conclusion The external pleural approach as a surgical method for the tre

关 键 词：胸膜外径路 胸腔镜 食管闭锁 食管气管瘘 

分 类 号：R459.9[医药卫生—治疗学]