先天性食管闭锁患儿术后吞咽困难危险因素分析  

Dysphagia in Patients Undergoing Esophageal Atresia Surgery:Risk Factors and Strategies for Management

作　　者：李爽爽 谢川平 赵勇 廖俊敏 刘恒鑫 黄金狮 LI Shuangshuang;XIE Chuanping;ZHAO Yong;LIAO Junmin;LIU Hengxin;HUANG Jinshi(Department of Neonatal Surgery,Beijing Children s Hospital,Capital Medical University,National Center for Children s Health,Beijing 100045,China;不详)

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 [2]国家儿童医学中心首都医科大学附属北京儿童医院耳鼻咽喉头颈外科/儿童耳鼻咽喉头颈外科疾病北京市重点实验室

出　　处：《听力学及言语疾病杂志》2025年第1期12-17,共6页Journal of Audiology and Speech Pathology

基　　金：首都临床诊疗技术研究及转化应用项目(Z211100002921062)。

摘　　要：目的探讨先天性食管闭锁患儿术后吞咽困难相关危险因素。方法对2016年7月-2023年8月于首都医科大学附属北京儿童医院接受先天性食管闭锁手术患儿103例的临床资料进行回顾性分析。结果103例先天性食管闭锁患儿中,74例术后出现吞咽困难(71.8%,74/103),其中持续时间0~≤6月17例,6~≤12月38例,>12月19例。术后吞咽困难单因素分析结果提示:一期手术(χ^(2)=4.017,P=0.045)、腔镜手术(χ^(2)=8.315,P=0.004)、长段缺失(χ^(2)=10.975,P<0.001)、胃食管反流(χ^(2)=16.973,P<0.001)、声带麻痹(χ^(2)=4.017,P=0.045)、气管软化(χ^(2)=5.778,P=0.016)、会厌运动不协调(χ^(2)=10.420,P=0.001)与术后吞咽困难发生相关;进一步二元logistic回归分析提示:腔镜手术(OR=24.373,P=0.016)、气管软化(OR=17.556,P=0.010)、吻合口狭窄(OR=20.453,P=0.032)是增加术后吞咽困难发生率的独立相关危险因素。进一步根据吞咽困难持续时间分层,多因素无序多分类logistic回归分析结果提示,气管软化(OR=16.883,P=0.007;OR=4.337,P=0.045)、长段缺失(OR=0.040,P=0.049;OR=0.040,P=0.036)、会厌运动不协调(OR=0.127,P=0.039;OR=0.510,P=0.028)与吞咽困难持续时间密切相关。结论吞咽困难是先天性食管闭锁患儿术后常见并发症,腔镜手术、长段缺失、气管软化和吻合口狭窄是导致术后吞咽困难的独立危险因素,而气管软化、长段缺失、会厌运动不协调与吞咽困难持续时间密切相关。Objective To investigate the occurrence of dysphagia in patients with congenital esophageal atresia(EA)after surgery and study the associated risk factors.Methods A retrospective analysis was conducted on clinical data of 103 children who underwent surgery for congenital EA at Beijing Children s Hospital,Capital Medical University,from July 2016 to August 2023.Results A total of 103 eligible cases of congenital EA were included in this study,among which 74 cases experienced dysphagia,with an incidence rate of 71.8%.Single-factor analysis revealed that primary surgery(χ^(2)=4.017,P=0.045),endoscopic surgery(χ^(2)=8.315,P=0.004),long-segment defects(χ^(2)=10.975,P<0.001),gastroesophageal reflux(χ^(2)=16.973,P<0.001),vocal cord paralysis(χ^(2)=4.017,P=0.045),tracheomalacia(χ^(2)=5.778,P=0.016),and arytenoid movement disorder(χ^(2)=10.420,P=0.001)were significantly associated with postoperative dysphagia.Further binary logistic regression analysis indicated that endoscopic surgery(OR=24.373,P=0.016),tracheomalacia(OR=17.556,P=0.010),and anastomotic stenosis(OR=20.453,P=0.032)were independent risk factors for increased incidence of postoperative dysphagia.Moreover,stratified analysis of dysphagia duration using unordered multinomial logistic regression revealed that tracheomalacia(OR=16.883,P=0.007;OR=4.337,P=0.045),long-segment defects(OR=0.040,P=0.049;OR=0.040,P=0.036),and arytenoid movement disorder(OR=0.127,P=0.039;OR=0.510,P=0.028)were closely associated with dysphagia duration.Conclusion Dysphagia is a common symptom in children with congenital EA after surgery across all age groups.Endoscopic surgery,long-segment defects,tracheomalacia,and anastomotic stenosis are independent factors contributing to postoperative dysphagia.Additionally,tracheomalacia,long-segment defects,and arytenoid movement disorder are closely related to the duration of dysphagia.

关 键 词：吞咽困难 先天性食管闭锁 危险因素 儿童 

分 类 号：R726.5[医药卫生—儿科]