Ⅲ型先天性食管闭锁胸腔镜手术治疗后吻合口狭窄的影响因素分析  

Analysis of influencing factors for anastomotic stricture after thoracoscopic repair of type Ⅲ congenital esophageal atresia

作　　者：颜斌 王哲 张瑜亮 关茜思 余家康 钟微 何秋明 Yan Bin;Wang Zhe;Zhang Yuliang;Guan Xisi;Yu Jiakang;Zhong Wei;He Qiuming(Department of Neonatal Surgery,Municipal Women&Children’s Medical Center,Guangzhou 510000,China;Department of Obstetrics&Gynecology,Third Affiliated Hospital,Guangzhou Medical University,Guangzhou 510623,China)

机构地区：[1]广州市妇女儿童医疗中心新生儿外科,广州510000 [2]广州医科大学附属第三医院妇产科,广州510623

出　　处：《临床小儿外科杂志》2025年第1期35-38,共4页Journal of Clinical Pediatric Surgery

基　　金：广州市科技项目(202201020614)。

摘　　要：目的探讨Ⅲ型先天性食管闭锁(congenital esophageal atresia,CEA)患儿胸腔镜手术治疗后出现吻合口狭窄的影响因素。方法回顾性分析2017年1月至2021年1月在广州市妇女儿童医疗中心接受胸腔镜手术治疗的Ⅲ型CEA患儿临床资料,将随访过程中出现吞咽困难、需行球囊扩张治疗的吻合口狭窄患儿归入狭窄组,无上述情况者归入非狭窄组,收集两组患儿性别、体重、胎龄、食管盲端距离、术后胃食管反流以及吻合口漏等情况,分析CEA手术后出现吻合口狭窄的相关因素。结果本研究共纳入33例CEA胸腔镜手术患儿,其中7例术后发生吻合口狭窄。单因素分析结果显示,术后吻合口漏(χ^(2)=7.757,P=0.005)、胃食管反流(χ^(2)=6.046,P=0.014)与CEA患儿胸腔镜手术后吻合口狭窄的发生相关。多因素逐步Logistic回归分析显示,吻合口漏(OR=19.167,95%CI:2.868~189.764,P=0.004)是CEA患儿胸腔镜手术后出现吻合口狭窄的独立危险因素。结论吻合口漏是胸腔镜手术治疗Ⅲ型CEA患儿出现术后吻合口狭窄的独立危险因素,建议针对吻合口漏优化手术操作和术后管理,以提高患儿术后生活质量。Objective To explore the influencing factors of anastomotic stricture after thoracoscopy in children with type Ⅲ congenital esophageal atresia(CEA).Methods A retrospective analysis was conducted for clinical data of 33 children with type Ⅲ CEA undergoing thoracoscopy at Guangzhou Women&Children’s Medical Center from January 2017 to January 2021.Patients with dysphagia requiring balloon dilatation during follow-ups were categorized into stricture group while those without these complications were assigned into non-stricture group.Potential influencing factors such as gender,weight,gestational age,gap length and anastomotic leakage were examined for determining their association with postoperative anastomotic stricture.Results Among them,7 cases developed anastomotic stricture.Univariate analysis indicated that postoperative gastroesophageal reflux(χ^(2)=6.046,P=0.014)and anastomotic leakage(χ^(2)=7.757,P=0.005)were significantly associated with anastomotic stricture after thoracoscopy(P<0.05).Multivariate stepwise Logistic regression analysis identified anastomotic leakage(OR=19.167,95%CI:2.868-189.764,P=0.004)as an independent risk factor for postoperative anastomotic stricture in CEA children(P<0.05).Conclusions Anastomotic leakage is an independent risk factor for anastomotic stricture after thoracoscopic repair of type Ⅲ CEA.Optimizing surgical techniques and postoperative managements for preventing anastomotic leakage is crucial for enhancing postoperative quality-of-life in type Ⅲ CEA children.

关 键 词：食管闭锁 先天性 胸腔镜检查 手术后并发症 外科吻合口 缩窄 病理性 吻合口漏 影响因素分析 儿童 

分 类 号：R726.5[医药卫生—儿科]