经胸膜外入路与经胸腔入路治疗先天性Ⅲ型食管闭锁的疗效比较  

Comparison of extrapleural and transpleural approach in the treatment of type Ⅲ congenital esophageal atresia

作　　者：宋冀硕 李洪波[1] 蒋茂林 王刚[1] 吴春[1] 潘征夏[1] 李勇刚[1] 代江涛[1] 赵录[1] 周悦航[1] SONG Jishuo;LI Hongbo;JIANG Maolin;WANG Gang;WU Chun;PAN Zhengxia;LI Yonggang;DAI Jiangtao;ZHAO Lu;ZHOU Yuehang(Department of Cardiothoracic Surgery,Children′s Hospital Affiliated to Chongqing Medical University/Key Laboratory of Child Development and Disease of Ministry of Education/Key Laboratory of Pediatrics of Chongqing/China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院/儿童发育疾病省部共建教育部重点实验室/儿科学重庆市重点实验室/儿童发育重大疾病国家国际科技合作基地心胸外科

出　　处：《重庆医学》2019年第17期2956-2959,共4页Chongqing medicine

基　　金：重庆市卫生和计划生育委员会2015年科研课题基金项目(2015XMGS)

摘　　要：目的探讨经胸膜外入路与经胸腔入路两种手术路径治疗先天性Ⅲ型食管闭锁的临床疗效。方法回顾性分析2017年1月至2018年9月在该院行手术治疗的42例先天性Ⅲ型食管闭锁患儿,均行食管端端吻合、食管气管瘘修补术。其中经胸膜外入路手术的患儿17例(观察组),经胸腔入路手术的患儿25例(对照组),比较两组患儿的手术时间、术后呼吸机使用时间及住院时间等。结果42例患儿均顺利完成手术,40例(95.24%)痊愈出院,2例因术后并发症放弃治疗死亡。观察组、对照组患儿手术时间分别为(96.00±7.73)、(93.64±4.47)min,两组比较差异无统计学意义(P=0.924);观察组、对照组患儿术后呼吸机使用时间分别为(3.91±2.13)、(6.44±4.17)d,术后住院时间分别为(20.53±4.16)、(26.05±9.07)d,两组比较差异均有统计学意义(P<0.05)。观察组患儿发生肺部相关并发症6例,吻合口瘘2例;对照组发生肺部相关并发症15例,吻合口瘘7例,两组患儿并发症比较差异无统计学意义(P>0.05)。结论经胸膜外入路手术治疗Ⅲ型食管闭锁较经胸腔入路手术对患儿肺部干扰更小、恢复更快、预后更好,先天性Ⅲ型食管闭锁开放手术可优先选择经胸膜外入路。Objective To compare the efficacy of extrapleural and transpleural approach in the treatment of typeⅢcongenital esophageal atresia.Methods A retrospective analysis was performed on 42 cases of typeⅢcongenital esophageal atresia who were operated and received esophageal end-to-end anastomosis and repair of esophageal tracheal fistula in our hospital from January 2017 to September 2018.Among them,17 patients were operated via extrapleural approach(the observation group)while 25 patients were operated via transpleural approach(the control group).Results All 42 patients were operated successfully,40 patients(95.24%)were cured and discharged,2 patients died due to complications.There was no significant difference in the operation time between the two approaches[(96.00±7.73)min vs.(93.64±4.47)min,P=0.924].There was a significant difference between the two approaches in the postoperative duration of ventilator using[(3.91±2.13)d vs.(6.44±4.17)d,P<0.05]and postoperative hospitalization time[(20.53±4.16)d vs.(26.05±9.07)d,P<0.05].6 cases of pulmonary complications and 2 cases of anastomotic leakage were found in the observation group,and 15 cases of pulmonary complications and 7 cases of anastomotic leakage were found in the control group,with no significant difference between them(P>0.05).Conclusion The treatment of typeⅢesophageal atresia via extrapleural approach is less invasive to lung which has better recovery and outcomes.The extrapleural approach should be considered prior in the open surgery of typeⅢesophageal atresia.

关 键 词：先天性食管闭锁 经胸膜外入路 经胸腔入路 

分 类 号：R726.1[医药卫生—儿科]