单中心10年先天性食管闭锁外科治疗及预后分析  

Surgical interventions and prognostic outcomes of congenital esophageal atresia for a decade at a single center

作　　者：冯众 何炜婧[1] 高润楠 朱海涛[1] 田钰欣 曹旭清 董岿然[1] 陈功[1] 沈淳[1] Feng Zhong;He Weijing;Gao Runnan;Zhu Haitao;Tian Yuxin;Cao Xuqing;Dong Kuiran;Chen Gong;Shen Chun(Department of Pediatric Surgery,Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院外科,上海201102

出　　处：《中华小儿外科杂志》2024年第2期107-113,共7页Chinese Journal of Pediatric Surgery

基　　金：上海市临床重点专科(shslczdzk057030);国家自然科学基金(81873849);上海市医学创新研究专项(21Y1907300)。

摘　　要：目的探讨先天性食管闭锁(esophageal atresia,EA)的治疗及患儿术后生活质量。方法收集2008年6月至2018年12月复旦大学附属儿科医院新生儿外科首次治疗的259例EA患儿的临床资料,其中男143例,女116例,统计合并畸形、放弃治疗、治愈率、EA分型、术后并发症等情况,并对术后中远期临床症状和生长发育情况进行随访。结果共计259例食管闭锁患儿在复旦大学附属儿科医院首次治疗,213例接受了手术,术后放弃治疗死亡或自动出院失随访19例。194例食管闭锁治愈并出院,术后治愈率为91.1%(194/213)。其中A型11例,C型179例,D型1例,E型3例。179例C型食管闭锁,其中99例开放手术,80例胸腔镜手术,胸腔镜手术吻合口狭窄率显著高于开放手术(55.0%比39.4%,P<0.05),但胸腔镜手术并非吻合口狭窄的独立危险因素。现有数据分析未发现吻合口漏的危险因素;但吻合口漏是食管气管瘘复发的独立危险因素。中远期临床症状主要以慢食为主,占65.0%;其次为进食后反流或烧心症状,占33.6%,1.6%需手术干预;术后脊柱侧弯有5.6%,以特发性、保守治疗为主,合并脊柱发育异常需要手术。EA患儿整体生长发育情况较好,仅8.8%年龄别身高<-2,生长发育迟缓,而食管复杂手术史是生长发育迟缓的影响因素。结论 EA患儿整体预后良好,但术后中远期随访存在相关临床症状,仍需要长期随访观察。Objective To summarize the clinical features of esophageal atresia(EA)over the last decade at a single center and to explore its related prognostic factors.Methods From June 2009 to December 2018,the relevant clinical data were retrospectively reviewed for 259 EA children.Postoperative follow-up profiles were collected,including complications,medium/long-term clinical symptoms and growth&development status.Results Among them,213 cases were operated and 19 cases refused surgery.And 194(194/213,91.1%)were discharged after recovery.Clinical types were A(n=11),C(n=179),D(n=1)and E(n=3).Open surgery(n=99)and thoracoscopy(n=80)were performed.The incidence of esophageal stenosis(ES)was significantly lower in open surgery group than that in thoracoscopic group(55.0%vs 39.4%,P<0.05).However,thoracoscopy was not an independent influencing factor of ES.No risk factors of anastomotic leakage were detected.Anastomotic leakage was an independent risk factor of recurrent tracheoesophageal fistula.Prolonged eating(65%,81/125)was one major postoperative clinical symptom.Reflux or heartburn was also common(33.6%,42/125)and>1.6%of them required surgical intervention.Scoliosis(5.6%,7/125)was generally idiopathic.One complicated case of spinal developmental malformation underwent surgery.Overall growth and development were decent.Only 8.8%of them developed growth retardation.A history of complex esophageal surgery was an influencing factor for growth retardation.Conclusion The overall prognosis of EA is generally favorable.However,long-term follow-ups are required.

关 键 词：食管闭锁 预后 并发症 生长发育 

分 类 号：R726.5[医药卫生—儿科]