胸腔镜手术治疗儿童先天性食管闭锁术后食管憩室  

Thoracoscopy for esophageal diverticulum after congenital esophageal atresia in children

作　　者：赵勇 黄金狮 王丁丁 华凯云 谷一超 张雅楠[1] 廖俊敏 李爽爽 赵家伟 Zhao Yong;Huang Jinshi;Wang Dingding;Hua Kaiyun;Gu Yichao;Zhang Yanan;Liao Junmin;Li Shuangshuang;Zhao Jiawei(Department of Neonatal Surgery,Beijing Children's Hospital,Capital Medical University,National Center of Children's Health,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》2023年第2期108-113,共6页Chinese Journal of Pediatric Surgery

基　　金：首都临床特色诊疗技术研究与转化应用(Z211100002921062)。

摘　　要：目的探讨胸腔镜手术治疗先天性食管闭锁术后食管憩室的手术经验及治疗效果。方法收集2018年11月至2021年5月在首都医科大学附属北京儿童医院进行先天性食管闭锁术后因食管憩室再行胸腔镜食管憩室切除手术5例患儿的临床资料,其中男1例,女4例,中位年龄为12.8个月,年龄范围为6.3~36.0个月,中位体重为8.0 kg,体重范围为6.5~10.5 kg。总结分析手术时间、手术出血量、住院时间、术后并发症及随访情况。结果本组5例均于胸腔镜下完成食管憩室切除手术,手术算术平均时间为2.3 h(1.5~3.6 h),手术出血量均<5 ml,术中均未输血;术后计划转入PICU。术后有创呼吸机平均使用时间为3 d(1~7 d);术后算术平均住院时间为16 d(10~21 d)。1例患儿术后1周行上消化道造影检查提示吻合口漏,术后2周复查,自愈。随访时间1~30个月。所有患儿均已完全经口喂养,生长发育良好,体重增长满意。结论先天性食管闭锁术后食管憩室罕见,临床表现主要为吞咽困难,进食时呛咳,反复上呼吸道感染,胸腔镜手术治疗胸腔食管憩室是安全有效的。Objective To explore the feasibility,surgical experience and therapeutic outcomes of video-assisted thoracoscopy for esophageal diverticulum after congenital esophageal atresia(CEA).Methods From November 2018 to May 2021,clinical data were retrospectively reviewed for 5 children undergoing thoracoscopic resection of esophageal diverticulum after CEA.There were 1 boy and 4 girls with a median age of 12.8(6.3-36.0)months and a median body weight of 8.0(6.5-10.5)kg.Operative duration,amount of blood loss,length of hospitalization stay,postoperative complications and follow-up results were recorded.Results All operations were completed successfully.Average operative duration was 2.3(1.5-3.6)hours and amount of blood loss<5 ml.No intraoperative blood transfusion was required.During a stay of pediatric intensive care unit(PICU),mean postoperative time of using invasive ventilator was 3(1-7)days and mean postoperative hospital stay 16(10-21)days.Upper gastrointestinal angiography hinted at anastomotic leakage at Week 1 postoperatively and the child recovered spontaneously within a week.During a follow-up period of(1-30)months,all of them resumed a normal diet and both growth and development were decent.Conclusions Esophageal diverticulum is rare after CEA.Its common clinical manifestations include dysphagia,coughing during ingestion and recurrent upper respiratory tract infection.Thoracoscopy is both safe and effective for thoracic esophageal diverticulum.

关 键 词：憩室 食管 先天性食管闭锁 胸腔镜 儿童 

分 类 号：R726.5[医药卫生—儿科]