Gross Ⅲ型先天性食管闭锁患儿胸腔镜食管成形术后发生吻合口并发症的影响因素  

Influencing factors of anastomotic complications after thoracoscopic esophagoplasty in children with congenital Gross Ⅲ esophageal atresia

作　　者：黄泓玮 冯得敏 傅哲 时红光[1] 曹振杰[1] HUANG Hong-wei;FENG De-min;FU Zhe;SHI Hong-guang;CAO Zhen-jie(Department of Pediatric General Surgery,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450014,China)

机构地区：[1]郑州大学第三附属医院小儿普外科,河南郑州450014

出　　处：《中华实用诊断与治疗杂志》2022年第11期1149-1152,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190351)。

摘　　要：目的 观察GrossⅢ型先天性食管闭锁患儿胸腔镜食管成形术后吻合口并发症发生情况,探讨术后发生吻合口并发症的影响因素。方法 59例GrossⅢ型先天性食管闭锁患儿均行胸腔镜食管成形术治疗,术后随访1个月~4年,发生吻合口瘘、吻合口狭窄19例为并发症组,未发生吻合口瘘、吻合口狭窄40例为无并发症组。比较2组胎龄,出生体质量,术前两盲端距离,血白蛋白、中性粒细胞比率、血红蛋白水平,手术时间,术后机械通气时间及胸腔引流时间等临床资料;多因素logistic回归分析GrossⅢ型先天性食管闭锁患儿胸腔镜食管成形术后发生吻合口并发症的影响因素。结果并发症组两盲端距离[(3.68±0.95)cm]、手术时间[(158.47±13.27)min)]、术后机械通气时间[(4.47±1.35)d]均长于无并发症组[(2.10±0.63)cm、(151.68±10.39)min、(3.30±0.56)d](t=7.624,P<0.001;t=2.145,P=0.036;t=4.734,P<0.001),出生体质量[(2.19±0.47)kg]、术前血白蛋白水平[(29.66±3.20)g/L]均低于无并发症组[(3.05±0.46) kg、(34.93±2.52)g/L](t=6.623,P<0.001;t=6.869,P<0.001),胎龄[(36.37±2.59)个月]短于无并发症组[(37.60±1.60)个月](t=2.250,P=0.028);2组性别,合并心脏畸形及其他畸形比率,术前中性粒细胞比率、血红蛋白水平及术后胸腔引流时间比较差异均无统计学意义(P>0.05)。两盲端距离(OR=10.858,95%CI:1.149~102.589,P=0.037)、出生体质量(OR=0.021,95%CI:0.434~0.893,P=0.043)、术前血白蛋白(OR=0.668,95%CI:0.451~0.990,P=0.045)是GrossⅢ型先天性食管闭锁患儿胸腔镜食管成形术后发生吻合口并发症的影响因素。结论 两盲端距离较长、低出生体质量、有低蛋白血症的GrossⅢ型先天性食管闭锁患儿胸腔镜食管成形术后易发生吻合口并发症。Objective To observe the occurrence of anastomotic complications after thoracoscopic esophagoplasty in children with congenital GrossⅢ esophageal atresia and to investigate its influencing factors.Methods Fifty-nine children with congenital GrossⅢ esophageal atresia were performed thoracoscopic esophagoplasty,and were divided into19 patients with anastomotic fistula or stricture (complication group)and 40 patients with no anastomotic fistula or stricture(no-complication group)according to the results of follow-up for 1 month to 4 years after surgery.The gestational age,birth weight,distance between two blind ends,preoperative albumin level,neutrophil ratio,hemoglobin level,operation time,postoperative mechanical ventilation time and thoracic drainage time were compared between two groups.Multivariate logistic regression analysis was done to analyze the influencing factors of the occurrence of anastomotic complications after thoracoscopic esophagoplasty in children with congenital GrossⅢesophageal atresia.Results The distance between two blind ends,operation time and postoperative mechanical ventilation time were longer in complication group[(3.68±0.95)cm,(158.47±13.27)min,(4.47±1.35)d]than those in no-complication group[(2.10±0.63)cm,(151.68±10.39)min,(3.30±0.56)d](t=7.624,P<0.001;t=2.145,P=0.036;t=4.734,P<0.001),the birth weight and preoperative serum albumin level were lower in complication group[(2.19±0.47)kg,(29.66±3.20)g/L]than those in no-complication group[(3.05±0.46)kg,(34.93±2.52)g/L](t=6.623,P<0.001;t=6.869,P<0.001),and the gestational age was shorter in complication group[(36.37±2.59)months]than that in no-complication group[(37.60±1.60)months](t=2.250,P=0.028).There were no significant differences in the gender,combined cardiac malformation rate,other malformation rate,preoperative neutrophil ratio,hemoglobin level and postoperative thoracic drainage time between two groups(P>0.05).The distances between two blind ends(OR=10.858,95%CI:1.149-102.589,P=0.037),birth weight(OR=0.021,95%CI

关 键 词：先天性食管闭锁 GrossⅢ型 胸腔镜食管成形术 吻合口瘘 吻合口狭窄 

分 类 号：R726.5[医药卫生—儿科]