胸腔镜食管气管瘘修补联合食管吻合术治疗Ⅲ型先天性食管闭锁的临床研究  

A clinical study on thoracoscopic esophagotracheal fistula repair combined with esophageal anastomosis in the treatment of type Ⅲ congenital esophageal atresia

作　　者：赵鸽[1] Zhao Ge(Department of Pediatric Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 45000,China)

机构地区：[1]郑州大学第一附属医院小儿外科,450000

出　　处：《临床医学》2025年第1期8-11,共4页Clinical Medicine

摘　　要：目的探讨Ⅲ型先天性食管闭锁患儿采用胸腔镜食管气管瘘修补联合食管吻合术治疗的效果。方法回顾性收集2019年8月至2023年8月郑州大学第一附属医院收治的71例Ⅲ型先天性食管闭锁患儿的临床资料。依据手术方法分为胸腔镜组(n=36)与开胸组(n=35),胸腔镜组给予胸腔镜食管气管瘘修补联合食管吻合术治疗,开胸组给予胸膜外入路开胸联合食管吻合术治疗。比较两组围术期相关指标(手术时间、呼吸机使用时间、术后进食时间、住院时间)、炎性因子[超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平及并发症。结果胸腔镜组手术时间长于开胸组,呼吸机使用时间、术后进食时间、住院时间短于开胸组,差异有统计学意义(P<0.05)。胸腔镜组术后3 d血清hs-CRP、TNF-α、IL-6水平低于开胸组,差异有统计学意义(P<0.05)。胸腔镜组术后12个月内并发症总发生率低于开胸组,差异有统计学意义(P<0.05)。结论Ⅲ型先天性食管闭锁患儿采用胸腔镜食管气管瘘修补联合食管吻合术治疗的手术时间较长,但术后进食时间、呼吸机使用时间、住院时间较短,且可减少术后炎症反应,降低术后并发症发生率。Objective To investigate the therapeutic effect of thoracoscopic esophagotracheal fistula repair combined with esophageal anastomosis on children with type Ⅲ congenital esophageal atresia.Methods The clinical data of 71 children with type Ⅲ congenital esophageal atresia treated in the First Affiliated Hospital of Zhengzhou University from August 2019 to August 2023 were retrospectively collected.They were divided into thoracoscopic group(n=36)and thoracotomy group(n=35)according to surgical methods.The thoracoscopic esophagotracheal fistula repair combined with esophagostomy was performed in the thoracoscopic group.In the thoracotomy group,extrapleural thoracotomy combined with esophagostomy was performed.The perioperative relevant indexes(operation time,ventilator use time,postoperative eating time,hospital stay),inflammatory factors[hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]levels and complications were compared between the two groups.Results The operative time of thoracoscope group was longer than that of thoracotomy group,and the ventilator use time,postoperative feeding time and hospital stay were shorter than those of thoracotomy group,with significant differences(P<0.05).The serum levels of hs-CRP,TNF-α and IL-6 in thoracoscope group at 3 days after surgery were lower than those in thoracotomy group,and the differences were significant(P<0.05).The total incidence of complications in the thoracoscopic group was lower than that in the thoracotomy group within 12 months after surgery,and the difference was significant(P<0.05).Conclusions The operation time of thoracoscopic esophagotracheal fistula repair combined with esophagostomy for type Ⅲ congenital esophageal atresia is longer,but the postoperative feeding time,ventilator use time and hospital stay are shorter,and the postoperative inflammatory response and postoperative complication rate can be reduced.

关 键 词：胸腔镜食管气管瘘修补术 食管吻合术 Ⅲ型先天性食管闭锁 

分 类 号：R726.5[医药卫生—儿科]