经漏口精准引流法治疗食管闭锁术后严重吻合口漏  

Clinical experiences of precise placement of suction drainage for esophageal atresia with major anastomotic leakage

作　　者：邬文杰[1] 张宁 施佳[1] 龚一鸣[1] 潘伟华[1] 俞炬明[2] 王俊[1] Wu Wenjie;Zhang Ning;Shi Jia;Gong Yiming;Pan Weihua;Yu Juming;Wang Jun(Department of Pediatric Surgery,Affiliated Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Interventional Radiology,Affiliated Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Neonatal Surgery,Municipal Children's Hospital,Xuzhou 221006,China)

机构地区：[1]上海交通大学医学院附属新华医院儿普外科,上海200092 [2]上海交通大学医学院附属新华医院放射介入科,上海200092 [3]江苏省徐州市儿童医院新生儿外科,徐州221006

出　　处：《中华小儿外科杂志》2023年第11期975-979,共5页Chinese Journal of Pediatric Surgery

基　　金：促进市级医院临床技能与临床创新能力三年行动计划(SHDC2020CR2063B)。

摘　　要：目的总结使用经食管漏口精准定位引流法治疗食管闭锁术后吻合口漏的经验及疗效。方法收集2018年1月至2023年3月上海交通大学附属新华医院儿普外科实施经漏口精准引流法治疗食管闭锁术后严重食管吻合口漏13例患儿的临床资料,其中男5例,女8例;诊断包括Ⅰ型食管闭锁3例,Ⅲa型食管闭锁1例,复发性食管气管瘘9例。所有病例均于X线透视下留置食管内经漏口引流管并给予持续负压吸引。同时给予常规抗感染、营养支持治疗,定期复查食管造影观察吻合口愈合情况,并逐步拔出引流管,以促进吻合口愈合。结果本组13例病例经治疗后吻合口漏均自愈。置管引流(16.7±6.8)d(7~28 d),人均调整引流管次数为(3.2±1.0)次(2~5次),引流管调整周期为(5.3±1.7)d(3.5~9.3 d),无置管相关并发症发生。ICU住院时间为(18.0±8.4)d(6~34 d),呼吸机使用时间为(8.3±7.5)d(2~26 d)。术后中位随访时间为28个月(1~52个月),并发症中吻合口狭窄4例,食管憩室2例,败血症、食管气管瘘复发、食管支气管瘘复发各1例。结论经漏口精准引流法治疗食管闭锁术后严重吻合口漏是安全、微创、有效的方法,应于吻合口漏发现早期进行治疗。Objective To summarize clinical experiences of precise placement of suction drainage for esophageal atresia(EA)with major anastomotic leakage.Methods From January 2018 to March 2023,13 EA children developed major anastomotic leakage.There were 5 boys and 8 girls.The clinical types were type I EA(n=3),typeⅢa(n=1)and recurrent tracheoesophageal fistula(n=9).An irrigation tube with continuous negative pressure was placed under guidance of X-ray.Conventional therapies of antibiotics and nurtritional suppors were offered.Regular re-examinations of esophageal contrast studies were performed for tracking the healing status of anastomotic opening.Gradual extracting was implemented for promoting anastomotic healing.Results All of them survived and closure of AL with suction drainage succeed.The mean duration of suction drainage was(16.7±6.8)(7-28)day with a mean changing frequency of drainage tube(3.2±1.0)(2-5).No severe placement of suction drainage-related adverse events occurreded.The median follow-up period was 28(1-52)month.The postoperative complications included sepsis(n=1),esophageal diverticula(n=2),anastomotic stricture(n=4),recurrent tracheoesophageal fistula(n=1)and bronchoesophageal fistula(n=1).Conclusions Precise placement of suction drainage therapy for EA with major anastomotic leakage is safe,mini-invasive and effective.

关 键 词：食管闭锁 食管气管瘘 吻合口漏 引流 保守治疗 

分 类 号：R726.5[医药卫生—儿科]