胸腔镜Ⅲ型食管闭锁矫治的技术改良  

Modified Measures of Thoracoscopic Operation for Type Ⅲ Esophageal Atresia

作　　者：张利兵 赵津亮 闫焕 周春龙 杨正兵 Zhang Libing;Zhao Jinliang;Yan Huan(Department of Cardiothoracic and Neonate Surgery, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China)

机构地区：[1]电子科技大学医学院附属妇女儿童医院心胸/新生儿外科成都市妇女儿童中心医院

出　　处：《中国微创外科杂志》2020年第3期227-229,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：成都市科技局科技惠民技术研发项目(2015-HM01-00581-SF)

摘　　要：目的探讨改良胸腔镜Ⅲ型食管闭锁矫治手术的应用价值。方法回顾性分析2017年6月~2019年3月行改良胸腔镜Ⅲ型食管闭锁矫治23例的临床资料,Ⅲa型9例,Ⅲb型14例;男13例,女10例;体重2.0~3.7 kg,平均2.65 kg;入院年龄5 h^12 d,平均3.5 d。气管插管全麻,双肺通气,左侧俯卧位,采用三孔法(2个孔靠近脊柱,1个孔在腋中线肩胛缘),气胸流量2 L/min,压力<5 mm Hg,术中维持脉搏氧饱和度(SpO 2)>85%。保留奇静脉弓,将其作为支撑把壁层胸膜缝合覆盖食管气管瘘残端;食管吻合在壁层胸膜浅面胸腔内进行,5-0可吸收缝线间断缝合或4-0倒刺可吸收线连续缝合。结果食管闭锁矫治均在胸腔镜下完成,无中转开胸,无输血。1例合并胃穿孔,开腹行胃穿孔修补及置管造瘘。手术时间90~160 min,平均125 min。术后吻合口漏11例,保守治愈10例,1例二次手术治愈。术后随访9~24个月,平均17个月,无食管气管瘘复发,无胃食管反流。术后3个月吻合口狭窄5例,经胃镜下探条扩张治愈。结论将操作孔后移行双肺通气胸腔镜食管闭锁矫治是可行的;保留奇静脉弓作为支撑将壁层胸膜瓣覆盖食管气管瘘残端有利于预防食管气管瘘复发。Objective To explore the value of the modified measures of thoracoscopic operation in the treatment of esophageal atresia(EA)with tracheoesophageal fistula(TEF).Methods A retrospective analysis was made on 23 cases of EA with TEF treated with modified thoracoscopic operation from June 2017 to March 2019,including 9 cases of Gross typeⅢa and 14 cases of Gross typeⅢb.There were 13 male cases and 10 female cases,weighted from 2.0 to 3.7 kg(mean,2.65 kg).The admission age ranged from 5 hours to 12 days old(mean,3.5 days old).The patients were placed under left dicubitus position and given general anesthesia with endotracheal intubation and double lung ventilation.The three-port technique was used(one under the margin of the scapular inferior angle,and two others close to the spine).The pneumothorax volume flow was 2L/min,with pressure under 5 mm Hg.The SpO 2 during the operation was above 85%.The azygos arch was reserved,which was used as a bridge together with nearby parietal pleura to cover the stunt of esophageal tracheal fistula.Esophageal anastomosis was completed by 5-0 absorbable interrupted suture or 4-0 barbed absorbable running suture above the parietal pleura.Results All the procedures of EA with TEF were completed uneventfully by thoracoscopy with no conversion or transfusion.One case accompanied with stomach perforation was repaired and gastrostomy was performed simultaneously by laparotomy.The operation time ranged from 90 to 160 min(mean,125 min).There were 11 cases of anastomotic leakage,among which 10 were cured by conservative therapy and 1 was cured with second operation by thoracotomy.The patients were followed up for 9-24 months(mean,17 months).There was no recurrence of TEF or gastroesophageal reflux.At 3 months after operation,5 patients were found with anastomotic stricture and were cured by sound dilatation monitored by gastroscopy.Conclusions It is feasible to move the ports backwards to benefit the double lung ventilation during the thoracoscopic operation for the esophageal atresia.It

关 键 词：食管闭锁 胸腔镜手术 改良 奇静脉弓 

分 类 号：R73[医药卫生—肿瘤]