长段缺失型食管闭锁治疗中临床吞咽评估的应用  

Application of clinical swallowing evaluation in the treatment of long-gap esophageal atresia children

作　　者：王俊丽[1] 邬文杰[2] 唐春燕[2] 张宁 王俊[1] 李斐[1] WANG Junli;WU Wenjie;TANG Chunyan;ZHANG Ning;WANG Jun;LI Fei(Developmental and Behavioral Pediatric Department&Child Primary Care Department,MOE-Shanghai Key Laboratory for Children’s Environmental Health;Department of Pediatric Surgery,Xinhua Hospital Affiliated to 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发育行为儿童保健科,教育部与上海市环境与儿童健康重点实验室 [2]上海交通大学医学院附属新华医院小儿普外科,上海200092

出　　处：《临床儿科杂志》2023年第1期18-24,共7页Journal of Clinical Pediatrics

基　　金：上海申康医院发展中心促进市级医院临床技能与临床创新三年行动计划项目(No.SHDC2020CR2063B)。

摘　　要：目的 分析定期进行临床吞咽评估(CSE)对长段缺失型食管闭锁(LGEA)患儿24月龄内并发症及生长发育的影响。方法 回顾性分析儿外科2016年1月—2022年1月进行LGEA手术患儿的临床资料。定期CSE随访的LGEA患儿纳入CSE组,未参与的纳入对照组,比较两组间并发症发生率以及24月龄内生长发育情况。结果 最终纳入分析的LGEA患儿50例。CSE组患儿19例,男11例、女8例,I型16例(2例伴瘘)、Ⅱ型2例、Ⅲa型1例,产前诊断12例。对照组患儿31例,男16例、女15例,I型28例、Ⅱ型3例(2例伴瘘),产前诊断21例。CSE组平均出生体重低于对照组,食管盲端距离长于对照组,差异均有统计学意义(P<0.05)。CSE组术后到完全经口喂养的间隔天数为34.0(22.0~76.0)天,对照组为46.0(18.0~181.0)天,差异有统计学意义(Z=2.30,P=0.028)。与对照组相比,CSE组的肺部感染发生率更低,6月龄时CSE组的WAZ和LAZ更低,24月龄时CSE组的低体重和生长迟缓检出率低于对照组,差异均有统计学意义(P<0.05)。CSE组24月龄内LAZ增长值高于对照组,差异有统计学意义(P<0.05)。结论 在LGEA患儿的长期治疗中定期进行CSE随访,可降低患儿24月龄内的肺部感染发生率,有利于术后早期完全经口喂养和体重身高的追赶。Objective To analyze the effect of clinical swallow evaluation(CSE) on the complications and growth of children with long gap esophageal atresia(LGEA) within 24 months of age. Methods The clinical data of children who underwent LGEA surgery from January 2016 to January 2022 were retrospectively analyzed. Children with LGEA who had regular CSE follow-up were included in the CSE group and those who did not participate in CSE were included in the control group. The incidence of complications and the growth of children within 24 months were compared between the two groups. Results A total of 50 children with LGEA were included in the analysis. There were 19 children(11 boys and 8 girls) in the CSE group, including 16 cases of type Ⅰ congenital esophageal atresia(2 cases with fistula), 2 cases of type Ⅱ and 1 case of type Ⅲa. Twelve children received prenatal diagnosis. In the control group, there were 31 children(16 boys and 15 girls), including 28 cases of typeⅠand 3 cases of type Ⅱ(2 cases with fistula). Prenatal diagnosis was obtained in 21 cases. The birth weight of the CSE group was lower than that of the control group, the difference distance of the blind end of the esophagus was longer than that of the control group, and the difference was significant(P<0.05). The interval from postoperative to complete oral feeding was 34.0(22.0-76.0) days in the CSE group and 46.0(18.0-181.0) days in the control group, and the difference was statistically significant(Z=2.30, P=0.028). Compared with the control group, the CSE group had a lower incidence of lung infection, lower weight-for-age z score(WAZ) and lower length-for-age z score(LAZ) at 6 months.The detection rates of underweight and stunting in the CSE group at 24 months were lower than those in the control group, and the differences were statistically significant(P<0.05). The increment value of LAZ in the CSE group at 24 months was higher than that in the control group, and the difference was statistically significant(P<0.05). Conclusions Regular CSE foll

关 键 词：长段缺失型食管闭锁 临床吞咽评估 肺部感染 营养状况 

分 类 号：R725.7[医药卫生—儿科]