胃镜下食管内夹闭小儿食管气管瘘的疗效分析  

Therapeutic outcome of esophago-tracheal fistula treated with endoscopic esophageal clipping

作　　者：张中喜 陈競芳[2] 邹加良 张清池 刘云钦 陈青林 江俊学 Zhang Zhongxi;Chen Jingfang;Zou Jialiang;Zhang Qingchi;Liu Yunqin;Chen Qinglin;Jiang Junxue(Department of General Surgery,Xiamen Branch,Children's Hospital of Fudan University,Xiamen 361006,China;Department of Gastroenterology,Xiamen Branch,Children's Hospital of Fudan University,Xiamen 361006,China;Key Municipal Laboratory of Pediatric Surgical Diseases of Xiamen,Xiamen 361006,China)

机构地区：[1]复旦大学附属儿科医院厦门医院,厦门市儿童医院普外科,厦门361006 [2]复旦大学附属儿科医院厦门医院,厦门市儿童医院消化科,厦门361006 [3]厦门市小儿外科疾病重点实验室,厦门361006

出　　处：《中华小儿外科杂志》2024年第1期31-35,共5页Chinese Journal of Pediatric Surgery

基　　金：厦门市医疗卫生指导项目(3502Z20209217)。

摘　　要：目的探讨胃镜下食管内夹闭小儿食管气管瘘的可行性及疗效。方法回顾性分析2020年3月至2022年3月复旦大学附属儿科医院厦门医院收治的4例胃镜下食管内夹闭瘘口的食管气管瘘患儿的临床资料。患儿1,男,食道异物引起食管气管瘘,胃镜检查确诊并行瘘口夹闭,初次夹闭年龄为1岁9个月,初次瘘口直径为10 mm。患儿2,男,先天性食管闭锁(Ⅲ型)术后食管气管瘘复发,食管造影及胃镜检查确诊并行瘘口夹闭,初次夹闭年龄为3个月,初次瘘口直径为3 mm。患儿3,女,先天性食管闭锁(Ⅲ型)术后食管气管瘘复发,术中纤支镜结合胃镜检查确诊并行瘘口夹闭,初次夹闭年龄为7个月。患儿4,男,Ⅱ型食管闭锁误诊为Ⅰ型食管闭锁,胃镜检查确诊并行瘘口夹闭,初次夹闭年龄为2岁,初次瘘口直径为1 mm。所有患儿持续随访,记录患儿夹闭瘘口所用的时间、出血量及末次随访时的总夹闭次数。结果所有患儿均在胃镜下食管内应用夹子装置夹闭食管气管瘘。平均夹闭瘘口的时间为18 min,范围在10~30 min;手术出血量均<1 ml。患儿1共夹闭6次,末次夹闭后随访4个月临床症状消失。患儿2共夹闭3次,末次夹闭后随访15个月临床症状消失。患儿3共夹闭2次,在本院夹闭为第2次夹闭,夹闭时瘘口直径为2 mm,夹闭后随访8个月仍间断呛咳、呼吸道感染症状反复发作。患儿4夹闭1次,随访1个月临床症状消失。结论胃镜下食管内夹闭瘘口治疗小儿食管气管瘘是可行的,且创伤小,住院时间短,费用低,值得推广,但需要进一步改进器械及夹闭方法降低复发率。Objective To explore the feasibility and efficacy of esophagotracheal fistula closure in children under gastroscopy.Methods Retrospective analysis was performed for the relevant clinical data of 4 children with esophagotracheal fistula undergoing gastroscopic closure from March 2020 to March 2022.Case 1 was a boy of esophagotracheal fistula due to esophageal foreign body.It was diagnosed definitely by gastroscopy and initially closed at 21 months.The diameter of primary fistula clamp was 10 mm.Cases 2 and 3 developed recurrent esophagotracheal fistula after surgery for congenital esophageal atresia(typeⅢ).Case 2 was a boy diagnosed by esophagography and gastroscopy and initially closed at 3 months.The diameter of primary fistula clamp was 3 mm.After a confirmation of intraoperative fibrobronchoscopy plus gastroscopy,Case 3 was a girl initially closed at 7 months.Case 4 was a boy of typeⅡesophageal atresia misdiagnosed as typeⅠesophageal atresia and confirmed by gastroscopy.He had an initial closure at 2 years.The diameter of primary fistula clamp was 1 mm.During regular follow-ups,closure duration,volume of blood loss and total count of clamps at the last follow-up were recorded.Results Esophagotracheal fistula was closed with clamps under gastroscopy.Average closure duration was 18(10-30)min and volume of blood loss<1 ml.Case 1 underwent closure for a total of 6 times and clinical symptoms disappeared at 4 months.Case 2 was closed thrice and clinical symptoms resolved at 15 months.Case 3 was clamped thrice and intermittent coughing and respiratory infection persisted at 8 months.In Case 4,closure was performed once and clinical symptoms disappeared at 1 month.Conclusions For esophagotracheal fistula in children,gastroscopic closure of esophageal fistula is efficacious with minimal trauma,shorter hospitalization stay and low expense.However,further improvement of instruments and closure modes are required for lowering the recurrent rate.

关 键 词：胃镜检查 食管气管瘘 诊断 治疗 

分 类 号：R725.7[医药卫生—儿科]