食管内负压引流对改善先天性食管闭锁术后疗效的作用  

Clinical efficacy of esophageal negative pressure drainage in improving congenital esophageal atresia

作　　者：林阳文 张旻中 邬文杰[1] 施佳[1] 龚一鸣[1] 俞炬明[2] 王俊[1] Lin Yangwen;Zhang Minzhong;Wu Wenjie;Shi Jia;Gong Yiming;Yu Juming;Wang Jun(Department of Pediatric Surgery,Affiliated Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Interventional Radiology,Affiliated Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院小儿外科,上海200092 [2]上海交通大学医学院附属新华医院介入放射科,上海200092

出　　处：《中华小儿外科杂志》2022年第4期299-304,共6页Chinese Journal of Pediatric Surgery

基　　金：上海市科委2019年度"科技创新行动计划"生物医药领域科技支撑项目(19441905500);2019年度"转化医学协同创新中心合作研究项目"(TM201910);上海申康医院发展中心临床研究项目(SHDC2020CR2063B)。

摘　　要：目的探讨食管重建术中留置食管引流管并持续负压引流对术后吻合口漏和吻合口狭窄的影响作用和临床效果。方法收集2013年1月至2019年12月在上海交通大学医学院附属新华医院接受手术治疗并痊愈出院的先天性食管闭锁(congenital esophageal atresia, CEA)患儿的相关资料。将放置食管引流管并术后持续负压引流的患儿作为A组, 将未放置食管引流管的患儿作为B组。本研究共纳入130例患儿, 其中男84例, 女46例;A组81例, 男51例, 女30例, 出生孕周为(37. 6± 2. 0)周, 出生体重为(2 737±482) g, 42. 0%(34/81)存在伴发畸形;B组49例, 男33例, 女16例, 出生孕周为(37.8±2. 2)周, 出生体重为(2 826±628) g, 32. 7%(16/49)存在伴发畸形。收集并比较两组患儿的人口统计学信息、手术方式及技巧、呼吸机使用、并发症及诊治情况。结果 71. 5%(93/130)的患儿接受胸腔镜手术, 28. 5%(37/130)的患儿接受开胸手术。所有患儿在术后达到经口喂养后出院, 术后随访时间范围为10~60个月。A组术后吻合口漏发生率低于B组, 为18. 5%(15/81)比34. 7%(17/49), 差异具有统计学意义(P=0. 038)。A组中Ⅰ型及Ⅱ型CEA患儿多于B组, 为45. 7%(37/81)比26. 5%(13/49), 差异具有统计学意义(P=0. 030)。A组术中食管近远端缺失长度较B组大, 为(3. 3± 1. 7) cm比(2. 7±1. 2) cm, 差异具有统计学意义(P=0. 039)。术后, A组的呼吸机使用时间较B组稍长, 为(8. 8±9. 2) d比(6. 1±7. 9) d, 差异无统计学意义(P=0. 090);A组住院时间少于B组, 为(48. 7± 38. 0) d比(68. 6±52. 9)d, 差异具有统计学意义(P=0. 015);A组吻合口狭窄的发生率高于B组, 65. 4%(53/81)比49. 0%(24/49), 差异无统计学意义(P=0. 064);在吻合口狭窄需行食管扩张次数方面两组的差异无统计学意义(P=0. 313), 为(10. 3±7.8)次比(8. 3±7. 1)次。结论食管重建术中留置食管引流管并持续负压引流可以有效降低患儿术后吻合口漏的发生率, 有Objective To explore the clinical efficacy of indwelling esophageal negative pressure drainage tube and continuous negative pressure drainage on postoperative anastomotic leakage and anastomotic stricture during esophageal reconstruction.Methods From January 2013 to December 2019,the relevant clinical data were collected from 130 children with congenital esophageal atresia(CEA).There were 84 boys and 46 girls.Children with esophageal drainage tube placement and postoperative continuous negative pressure drainage were selected as group A(n=81)while those without esophageal tubing as group B(n=49).In group A,there were 51 boys and 30 girls with a birth age of(37.6±2.0)weeks and a birth weight of(2737±482)grams.And 42.0%(34/81)were malformed.In group B,there were 33 boys and 16 girls with a birth age of(37.8±2.2)weeks and a birth weight of(2826±628)grams.And 32.7%(16/49)were malformed.Demographic profiles,surgical approaches&techniques,ventilator use,complications and diagnosis&treatment were compared between two groups.Results Thoracoscopy(71.5%,93/130)and thoracotomy(28.5%,37/130)were performed.Discharges occurred after achieving feeding and postoperative follow-up period ranged from 10 to 60 months.The postoperative incidence of anastomotic leakage was lower in group A than that in group B[18.5%(15/81)vs 34.7%(17/49)]and the difference had statistical significance(P=0.038).There were more children with typeⅠ&ⅡCEA in group A than in group B[45.7%(37/81)vs 26.5%(13/49)]and the difference was statistically significant(P=0.030).The intraoperative proximal and distal esophageal distance was greater in group A than that in group B[(3.3±1.7)vs(2.7±1.2)cm]and the difference had statistical significance(P=0.039).After operation,ventilator time was slightly longer in group A than that in group B[(8.8±9.2)vs(6.1±7.9)days]and the difference had no statistical significance(P=0.090);hospital stay was shorter in group A than that in group B[(48.7±38.0)vs(68.6±52.9)days]and the difference had statistical significan

关 键 词：食管 负压引流 先天性食管闭锁 吻合口漏 吻合口狭窄 

分 类 号：R725.6[医药卫生—儿科]