先天性食管闭锁术后胸腔感染的临床特点分析  

Clinical characteristics of thoracic infections after repairing congenital esophageal atresia

作　　者：刘兆州 赵家伟 李思琪 王沛则 杨深 黄金狮 Liu Zhaozhou;Zhao Jiawei;Li Siqi;Wang Peize;Yang Shen;Huang Jinshi(Department of Neonatal Surgery,Affiliated Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院新生儿外科,北京100045

出　　处：《中华小儿外科杂志》2022年第7期599-603,共5页Chinese Journal of Pediatric Surgery

基　　金：北京市科学技术委员会课题资助项目(Z211100002921062)。

摘　　要：目的探究先天性食管闭锁(congenital esophageal atresia, CEA)术后发生胸腔感染的相关因素, 为临床诊疗及预防提供经验。方法收集2007年1月至2022年1月在北京儿童医院行手术治疗的207例Ⅲ型CEA患儿的基本临床资料。其中, 男141例, 女66例;出生体重为(2.90±0.49)kg;中位手术年龄为4.0 d。食管盲端远近端之间的距离为(1.66±1.03) cm。84.1%(174/207)的患儿伴发其他畸形;8.7%(18/207)的患儿被诊断为VACTERL综合征, 包括心脏畸形17例、肛门直肠畸形3例、脊柱或锥体畸形8例、泌尿系统畸形5例和肢体畸形5例。46.9% (97/207)的患儿在术前存在肺炎表现。根据术后是否发生胸腔感染分为感染组24例和非感染组183例, 比较两组间临床特征差异, 并通过单因素分析探究CEA术后胸腔感染的相关因素。结果 35.7%(74/207)的患儿接受胸腔镜手术治疗, 64.3%(133/207)的患儿接受开胸手术治疗;胸膜外入路手术99例, 胸膜内入路手术108例。术后并发症包括胸腔感染24例、气胸94例、吻合口漏74例、吻合口狭窄73例和复发性食管气管瘘13例。从胸腔感染患儿的胸水中分离出致病菌31株, 其中58.1 % (18/31)为革兰氏阳性菌, 41.9%(13/31)为革兰氏阴性菌。感染组气胸发生率为91.7%(22/24), 吻合口漏发生率为70.8%(17/24);非感染组气胸发生率为39.3%(72/183), 吻合口漏发生率为31.1 %(57/183)。与非感染组相比, 感染组的开胸手术比例大, 且气胸、吻合口漏发生率较高, 差异均具有统计学意义(P<0.05)。而在性别、合并综合征、食管盲端远近端之间的距离、术前肺炎、手术年龄、手术入路、术后机械通气、胸腔引流管留置时间及术后住院时间方面, 两组之间差异无统计学意义(P>0.05)。结论 CEA开胸手术更易发生胸腔感染, 气胸和吻合口漏可能与胸腔感染的发生密切相关。Objective To explore the related factors of thoracic infection after congenital esophageal atresia(CEA)surgery and to provide experiences for clinical diagnosis,treatment and prevention.Methods From January 2007 to January 2022,clinical data were retrospectively reviewed for 207 children with typeⅢCEA undergoing surgery.There were 141 boys and 66 girls with a median weight of(2.90±0.49)kg and a median operative age of 4.0 days.The distance between distal and proximal ends of blind esophageal end was(1.66±1.03)cm.Other malformations were diagnosed in 84.1%(174/207).And 8.7%(18/207)of them were diagnosed as VACTERL syndrome,including cardiac malformations(n=17),anorectal malformations(n=3),spinal/pyramidal malformations(n=8),urinary malformations(n=5)and 5 extremity malformations(n=5).Pneumonic manifestations were present preoperatively in 46.9%(97/207).They were divided into infection group(n=24)and non-infection group(n=183)according to the occurrence or not of postoperative thoracic infection.The inter-group differences in clinical characteristics were compared and the related factors of thoracic infection after CEA examined by univariate analysis.Results Among them,35.7%(74/207)underwent thoracoscopy and 64.3%(133/207)thoracotomy;99 patients were operated by extrapleural approach and 108 by intrapleural approach.Postoperative complications included thoracic infection(n=24),pneumothorax(n=94),anastomotic leakage(n=74),anastomotic stricture(n=73)and recurrent esophagotracheal fistula(n=13).Thirty-one pathogenic bacteria were isolated from pleural fluid of children with thoracic infections,of which 58.1%(18/31)were Gram-positive bacteria and 41.9%(13/31)were Gramnegative bacteria.The incidence of pneumothorax was 91.7%(22/24)and anastomotic leakage 70.8%(17/24)in infected group;the incidence of pneumothorax was 39.3%(72/183)and anastomotic leakage 31.1%(57/183)in non-infected group.The incidence of thoracotomy,pneumothorax and anastomotic leakage was higher in infected group than that in non-infected group and

关 键 词：食管闭锁 先天畸形 胸腔感染 临床特点 

分 类 号：R726.5[医药卫生—儿科]