胃镜下钳夹治疗复发性气管食管瘘的疗效观察与分析  

Gastroscopic treatment of recurrent tracheoesophageal fistula with titanium clipping

作　　者：孙松[1] 陈功[1] 董岿然[1] 郑珊[1] 唐子斐 马丽黎 吴婕 沈淳[1] Sun Song;Chen Gong;Dong Kuiran;Zheng Shan;Tang Zifei;Ma Lili;Wu Jie;Shen Chun(Department of Surgery Children's Hospital of Fudan University,Shanghai 201102,China;Department of Gastroenterology,Children's Hospital of Fudan University,Shanghai 201102,China;Endoscopy Center,Affiliated Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属儿科医院外科,上海201102 [2]复旦大学附属儿科医院消化科,上海201102 [3]复旦大学附属中山医院内镜中心,上海200032

出　　处：《中华小儿外科杂志》2021年第11期966-970,共5页Chinese Journal of Pediatric Surgery

基　　金：第四批上海市青年医师培养资助计划 (EK00000136)。

摘　　要：目的探讨胃镜下钳夹治疗复发性气管食管瘘(recurrent tracheoesophageal fistula,rTEF)的技术要点,评估治疗效果及预后情况。方法回顾性分析2019年5~11月复旦大学附属儿科医院采用胃镜下钳夹治疗4例rTEF患儿的临床资料。4例患儿中,男女各2例,接受胃镜下钳夹治疗的年龄为5月龄至6岁,体重为4~16.5 kg。4例患儿均为食管闭锁(esophageal atresia,EA)一期根治术后,其中2例为Ⅲb型,1例为Ⅲa型;另1例初次手术于当地医院完成,具体分型不详。结果4例rTEF患儿存在5处TEF,共进行7次胃镜下钳夹术,手术时间9~46 min。其中2例患儿分别钳夹1次后瘘口愈合;1例存在2处瘘口的患儿钳夹3次后愈合;另有1例患儿钳夹2次后仍存在rTEF,进行手术治疗后治愈。3例内镜治疗成功的患儿分别随访4~7个月,呛咳、反复肺炎等症状消失,复查食管造影及胃镜未见TEF复发,手术治疗和随访过程中均无其他并发症发生。结论胃镜下钳夹治疗EA术后rTEF安全,短期随访具有良好疗效,可作为治疗该疾病的一种新的手术选择。Objective To explore the technical points of endoscopic clipping in treating the recurrent tracheoesophageal fistula(rTEF),and to evaluate the therapeutic effect and prognosis.Methods The clinical data of 4 children with rTEF treated by gastroscopic clipping in Children's Hospital of Fudan University from May to November 2019 were retrospectively analyzed.Among the 4 patients,2 were males and 2 were females.The ages of patients ranged from 5 months to 6 years old,and the weight ranged from 4 to 16.5 kg.All the 4 children had underwent radical surgery due to esophageal atresia(EA),including 2 cases of typeⅢb and 1 case of typeⅢa.In the other case,the primary operation was performed at a local hospital,so the classification is unknown.Results There were 5 fistulas in 4 patients,and a total of 7 gastroscopic operations were performed,among which 2 children were clamped for 1 time before the fistula healed,1 child with two fistulas was clamped for 3 times before healing,and another child was still found to have TEF recurrence after clamping for 2 times.The operation time was 9-46 mins.The 3 children with successful treatment were followed up for 4-7 months,and choking and repeated pneumonia disappeared.No TEF was found in esophageal contrast and gastroscopy.No other complications occurred during surgical treatment and follow-up.Conclusions Endoscopic clipping treatment is safe and effective for rTEF after EA surgery,and can be used as a new minimally invasive surgical option for the treatment of this disease.

关 键 词：食管闭锁 气管食管瘘 胃镜检查 治疗结果 

分 类 号：R726.5[医药卫生—儿科]