先天性食管闭锁553例临床特征分析  

Congenital esophageal atresia:clinical report of 553 cases

作　　者：邹婵娟[1] 董洁 李波 李明 肖咏 许光[1] 李碧香[1] 周崇高[1] Zou Chanjuan;Dong Jie;Li Bo;Li Ming;Xiao Yong;Xu Guang;Li Bixiang;Zhou Chonggao(Department of Fetal&Neonatal Surgery,Hunan Children's Hospital,Changsha 410007,China;Pediatrics Research Institute of Hunan Province,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院胎儿与新生儿外科,长沙410007 [2]湖南省儿童医院儿科医学研究所,长沙410007

出　　处：《中华新生儿科杂志（中英文）》2024年第2期70-74,共5页Chinese Journal of Neonatology

基　　金：湖南省出生缺陷协同防治科技重大专项(2019SK1015);湖南省卫生健康委课题(202306028536)。

摘　　要：目的探讨先天性食管闭锁(congenital esophageal atresia,CEA)患儿的临床特征及食管闭锁根治(esophageal repair,ER)术后患儿死亡的危险因素。方法选择湖南省儿童医院2010年1月至2022年12月所有经胸腹X线片及食管造影确诊为CEA的患儿进行回顾性分析,根据是否行ER手术分为ER组和非ER组,ER组再根据出院结局分为存活组和死亡组,分析ER和非ER患儿的临床特征及ER患儿死亡的危险因素。结果共纳入553例CEA患儿。根据Gross分型,A、B、C、D、E型分别有29例(5.2%)、2例(0.4%)、504例(91.1%)、6例(1.1%)和11例(2.0%),1例为单纯隔膜闭锁。ER组406例,非ER组147例。非ER组早产、低出生体重、合并心脏畸形、其他消化道畸形、脊柱或肢体畸形比例高于ER组,差异均有统计学意义(P<0.05)。406例ER患儿中,开胸手术152例、胸腔镜手术243例、胸腔镜改开胸11例,术后吻合口漏92例;391例存活、15例死亡;住院时间23(17,36)d。与存活组相比,死亡组早产、低出生体重、胸腔镜改开胸及术后气管插管机械通气比例较高,住院天数较短,差异均有统计学意义(P<0.05);校正出生体重后,胸腔镜改开胸(OR=9.585,95%CI 1.899~48.374)、术后气管插管机械通气(OR=7.821,95%CI 1.002~61.057)是ER患儿死亡的危险因素。结论非ER患儿早产、低出生体重及合并畸形的比例高于ER患儿;胸腔镜手术为CEA的主要手术方式;早产、低出生体重、胸腔镜改开胸、术后气管插管机械通气是ER患儿死亡的危险因素。Objective To study the clinical characteristics of congenital esophageal atresia(CEA)and risk factors of mortality associated with esophageal repair(ER)surgery.Methods From January 2010 to December 2022,patients diagnosed of CEA using chest and abdomen X-ray and esophagography in our hospital were retrospectively reviewed.The patients were assigned into ER group and non-ER group according to the treatments.The ER group was subgrouped into survival group and death group according to the prognosis.Clinical data and outcomes were collected and compared between the groups.Results A total of 553 cases were enrolled.According to Gross classification,29 patients(5.2%)were type A,2 patients(0.4%)were type B,504 patients(91.1%)were type C,6 patients(1.1%)were type D and 11 patients(2.0%)were type E.One patient had simple transluminal septal atresia of the esophagus.406 patients were in ER group and 147 in non-ER group.Compared with ER group,non-ER group had significantly higher incidences of preterm birth,low birth weight and overall malformations(all P<0.05).In ER group,152 patients(37.4%)received open thoracic surgery(OTS),243(59.9%)had video-assisted thoracoscopic surgery(VATS)and 11(2.7%)were VATS converted to OTS.Postoperative anastomotic leakage(PAL)occurred in 92 patients(22.7%)and 15 patients(3.7%)died after surgery.The median length of hospital stay was 23(17,36)d.Compared with the survival group,the death group had higher incidences of preterm birth,low birth weight,VATS converted to OTS,mechanical ventilation after ER,and shorter length of hospital stay(all P<0.05).After adjusted for birth weight,VATS converted to OTS(OR=9.585,95%CI 1.899-48.374)and mechanical ventilation after ER(OR=7.821,95%CI 1.002-61.057)were risk factors of mortality in ER patients.Conclusions Non-ER patients have higher incidences of preterm birth,low birth weight and overall malformations than ER patients.VATS is the method of choice for CEA.Preterm birth,low birth weight,VATS converted to OTS and mechanical ventilation after ER are risk

关 键 词：先天性食管闭锁 临床特征 食管闭锁根治 医院死亡 危险因素 

分 类 号：R726.5[医药卫生—儿科]