完全经胸膜外径路手术治疗Ⅲ型先天性食管闭锁疗效观察  

Clinical observation of complete extrapleural approach in the treatment of typeⅢcongenital esophageal atresia

作　　者：莫优炼[1] 胡小华[1] 钟陈[1] 张平锋[1] 冯大军[1] 张家德[1] 苏嘉鸿 吴家成 吴超 MO You-lian;HU Xiao-hua;ZHONG Chen;ZHANG Ping-feng;FENG Da-jun;ZHANG Jia-de;SU Jia-hong;WU Jia-cheng;WU Chao(Department of Pediatric Surgery,Zhongshan Boai Hospital(Zhongshan Maternal and Child Health Hospital),Zhongshan 528403,Guangdong,CHINA)

机构地区：[1]中山市博爱医院(中山市妇幼保健院)小儿外科,广东中山528403

出　　处：《海南医学》2023年第3期340-343,共4页Hainan Medical Journal

基　　金：广东省中山市第三批社会公益与基础研究专项(医疗卫生重大、重点项目)(编号:2021B3002)。

摘　　要：目的观察完全经胸膜外径路手术治疗Ⅲ型先天性食管闭锁的临床疗效。方法回顾性分析中山市博爱医院2003年1月至2021年7月期间收治的48例Ⅲ型食管闭锁患儿的临床资料。根据其不同的手术方式,将其分为观察组28例(采用完全经胸膜外入路手术治疗)和对照组20例(采用经胸腔入路手术治疗)。比较两组患儿的治疗结局、手术相关指标(手术时间、呼吸机使用时间、胸膜外引流管使用时间、胃管/十二指肠营养管留置时间、住院时间)、术后并发症、吻合口瘘、吻合口狭窄的发生率和气管食管瘘复发率。结果48例患儿均顺利完成手术,38例患儿治愈出院,其中观察组24例,对照组14例;观察组中25例一期完成食管气管瘘修补+食管吻合术,1例行食管气管瘘修补,拒绝行胃造瘘手术,术后放弃治疗死亡,3例因术后并发症家属放弃治疗后死亡;对照组中16例一期完成食管气管瘘修补+食管吻合术,2例行食管气管瘘修补,拒绝行胃造瘘手术,术后放弃治疗死亡,2例因术后并发症家属放弃治疗后死亡;观察组患儿的手术时间、呼吸机使用时间、胸膜外引流管使用时间、胃管/十二指肠营养管留置时间、住院时间分别为(140.00±32.90)min、(3.68±0.54)d、(16.58±4.36)d、(34.62±8.64)d、(40.62±10.53)d,明显短于对照组的(162.36±34.24)min、(6.27±1.24)d、(23.97±3.28)d、(59.67±10.65)d、(62.64±9.34)d,差异均具有统计学意义(P<0.05);观察组患儿术后并发症发生率为14.29%,明显低于对照组的40.00%,差异具有统计学意义(P<0.05);观察组患儿的吻合口瘘发生率、吻合口狭窄发生率、气管食管瘘复发率分别为25.00%、21.43%、7.14%,略低于对照组的30.00%、25.00%、10.00%,但差异均无统计学意义(P>0.05)。结论完全经胸膜外径路手术治疗Ⅲ型先天性食道闭锁的效果显著,该术式对胸腔干扰少,术后并发症少,能有效地改善患儿肺部的炎症,可以早�Objective To observe the clinical effect of complete extrapleural approach in the treatment of typeⅢcongenital esophageal atresia.Methods The clinical data of 48 patients with typeⅢesophageal atresia admitted to Zhongshan Boai Hospital from January 2003 to July 2021 were analyzed retrospectively.According to their different surgical methods,they were divided into the observation group(28 cases,complete extrapleural approach)and the control group(20 cases,transthoracic approach).The treatment outcome,operation related indicators(operation time,time of applying ventilator,time of using extrapleural drainage tube,retention time of gastric tube/duodenal nutrition tube,length of hospital stay),postoperative complications,incidence of anastomotic leakage,anastomotic stenosis,and recurrence rate of tracheoesophageal fistula were compared between the two groups.Results Forty-eight patients successfully completed the operation,and 38 were cured and discharged,including 24 in the observation group and 14 in the control group.In the observation group,25 patients completed esophagotracheal fistula repair+esophagostomy in one stage;1 patient only underwent esophagotracheal fistula repair and refused to receive gastrostomy,who gave up treatment and died after surgery;3 patients died after giving up treatment due to postoperative complications.In the control group,16 patients completed esophagotracheal fistula repair+esophagostomy in one stage;2 patients underwent only esophagotracheal fistula repair and refused to receive gastrostomy,who died after giving up treatment;2 patients died after giving up treatment due to postoperative complications.The operation time,time of applying ventilator,time of using extrapleural drainage tube,retention time of gastric tube/duodenal nutrition tube,length of hospital stay in the observation group were(140.00±32.90)min,(3.68±0.54)d,(16.58±4.36)d,(34.62±8.64)d,and(40.62±10.53)d,which were significantly shorter than(162.36±34.24)min,(6.27±1.24)d,(23.97±3.28)d,(59.67±10.65)d,and(62.

关 键 词：胸膜外径路 Ⅲ型先天性食管闭锁 新生儿 胸腔入路 并发症 吻合口瘘 

分 类 号：R655.4[医药卫生—外科学]