机构地区：[1]西京学院医学院,西安710123 [2]西北妇女儿童医院,西安710061 [3]西安交通大学第二附属医院小儿外科,西安710004 [4]四川大学华西医院消化内镜中心,成都610041 [5]西安市儿童医院新生儿外科,西安710043 [6]西安市儿童医院消化内科,西安710043 [7]西安交通大学第一附属医院肝胆外科,西安710061
出 处：《科学通报》2020年第13期1264-1273,共10页Chinese Science Bulletin
基 金：国家自然科学基金(81470896,81700545,30830099,81127005,51275387);陕西省卫生和计划生育委员会自然科学基金(2014D85);陕西省自然科学基础研究计划(2017JQ8021);陕西省科技资源开放共享平台项目(S2016TFPT0024)资助。
摘 要：新生儿消化道闭锁或狭窄是常见的先天性结构畸形疾病,需要手术治疗.长段型先天性食管闭锁(long-gap esophageal atresia, LGEA)伴或不伴有气管-食管瘘(tracheoesophageal fistula, TEF)与难治性食管狭窄(refractory esophageal stricture, RES),是临床治疗的难题.前者临床治疗周期长,部分患儿甚至因食管壁张力较大导致吻合口撕裂、吻合口瘘等并发症.术后吻合口狭窄是先天性食管闭锁(congenital esophageal atresia, CEA)行开胸或经胸腔镜手术后常见并发症.大多数食管狭窄病例经内镜下扩张手术可缓解病情,但有部分病例虽经多次内镜下扩张仍反复出现瘢痕性狭窄而需要再次开胸手术切除狭窄段瘢痕组织并重新进行食管吻合,再次手术后仍面临再狭窄的可能,严重影响患儿喂养和生长发育.磁吻合(magnetic compressive anastomosis, MCA)技术通过磁体间压榨作用使受压组织坏死脱落,同时局部相邻组织结构层次准确对位,实现黏膜-黏膜层良好愈合,从而形成较理想的吻合效果.临床研究中,采用MCA技术有助于实现盲端距离≤3 cm的LGEA一期吻合,并为食管吻合术后发生吻合口严重狭窄并发症提供一种可行的微创治疗选择.此外, MCA技术还可用于肠造口术后恢复远端肠管排便功能的一种可靠方法.对于儿童先天性直肠闭锁畸形,传统方法需要经后矢状入路切开骶尾部盆底组织,对患儿盆底解剖结构损伤较大.由于不可避免地切断直肠后方的盆底肌群与神经纤维,故并发症较多,部分患儿术后排便功能受到很大影响. MCA可以保留盆底肌、直肠扩张肌与神经丛等解剖结构,排除了手术创伤因素对术后排便功能的影响.对于部分病情复杂的先天性消化道发育畸形患儿, MCA技术是一种效果可靠的临床治疗方法,基于临床应用的适用于儿童消化道吻合的系列磁性医疗器械可作为儿童外科疾病手术器械的有益补充.Malformation of digestive tract is common in neonates. Esophageal atresia(EA) comprises a group of congenital abnormalities defined by discontinuity of the esophagus. EA with communication with the trachea is known as tracheoesophageal fistula(TEF). For the repair of EA, it is needed to establish an anastomosis between two structures that may be significantly spaced apart, such as in long-gap EA(with a gap >3 cm). The repair across a long-gap can induce tension on the anastomosis, leading to dehiscence, anastomotic leak, or procedure failure. In neonatal patients with long-gap EA with TEF, the complications of significant gastroesophageal reflux, or anastomotic leaks and severe refractory esophageal stricture after surgery are common, which remains challenging for pediatric surgery.There are multiple options for lengthening and approximating the ends in long-gap EA such as myotomies, Gough flap, or the Foker technique. The treatment of long gap EA usually requires thoracotomy or thoracoscopy to place traction sutures on each esophageal in multiple stage operations, the treatment period of which is long. Esophageal stricture is the most common complication following EA repair. Refractory esophageal anastomotic stricture after repair of EA in infants is a challenging surgical problem. In general, these strictures can be successfully managed using endoscopic techniques including bougie and balloon dilation, stenting, and chemotherapeutic agents. If these techniques are unsuccessful, treatment options are limited to surgical resection of the strictured segment and reanastomosis, or esophageal replacement. Magnetic compression anastomosis(MCA) has been introduced for several decades. Recently, rare-earth magnets have been employed to create solid anastomosis for long-gap EA and refractory esophageal stricture in children. In MCA, a sutureless anastomosis of the gastrointestinal tract can be formed using two magnetic Harrison rings.Magnetic compress has been shown to be effective for the treatment of long-gap EA in chi
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