新生儿Ⅰ期胃代食管术治疗长段型食管闭锁

目的 探讨Ⅰ期胃代食管术治疗长段型食管闭锁的疗效.方法 对2008年3月至2013年12月采用Ⅰ期胃代食管术治疗的11例长段型食管闭锁进行回顾性分析,其中男8例,女3例.入院后行食管造影确诊,其中Ⅰ型2例,Ⅲa型9例.结果 所有患儿均顺利完成手术.9例治愈出院,1例死亡,1例家长放弃治疗.术后6例有严重肺炎,近期吻合口瘘2例.随访6个月至5年,吻合口狭窄3例,均行食管扩张术治愈,轻度胃食管反流6例,均未行抗反流手术,采用少量多餐及体位喂养治疗后症状缓解.结论 新生儿期采用Ⅰ期胃代食管术治疗长段型食管闭锁临床可行,避免了分期手术,缩短了治疗周期,有助于提高治愈率.     

食管闭锁的诊断和治疗

目的：探讨先天性食管闭锁的临床特点及治疗。 方法：回顾性分析食管闭锁患儿18例临床资料，其中5例放弃手术治疗，余13例均行手术治疗。 结果：13例行一期食管气管瘘结扎+食管闭锁切除端端吻合手术治疗的患者中，存活11例，4例发生吻合口狭窄，给予球囊扩张治愈；2例发生吻合口瘘，1例保守治愈，1例再次手术治愈；1例再发气管食管瘘再次手术治愈。死亡2例，分别于术后第3天和第6天死于呼吸衰竭、吻合口瘘及心衰。 结论：早期诊断、并发症的预防和积极处理是提高食管闭锁手术治疗效果的关键。     

胸腔镜治疗先天性食管闭锁Ⅲ型74例北大核心CSCD

目的探讨胸腔镜技术治疗先天性食管闭锁Ⅲ型的临床疗效。方法回顾2015年1月~2020年10月74例胸腔镜治疗先天性食管闭锁Ⅲ型的临床资料,年龄(2.1±2.3)d,体重(2.66±0.50)kg。早产儿20例(27.0%),产前检查提示食管闭锁16例(21.6%),合并其他疾病31例(41.9%)。均行胸腔镜气管食管瘘结扎,73例食管端端吻合,1例胃造瘘。结果66例(89.2%)完成胸腔镜手术,8例中转开胸。手术时间(178.5±68.3)min,住院时间(19.7±11.7)d,住院费用(9.8±5.6)万元。术后4例放弃治疗死亡,70例(94.6%)治愈出院。术后吻合口漏9例(12.9%),乳糜胸1例(1.4%)。术后随访1~5(2.8±1.4)年,吻合口狭窄32例(45.7%),气管食管瘘复发3例(4.3%),严重胃食管反流2例(2.9%),严重气管软化1例(1.4%)。结论胸腔镜治疗先天性食管闭锁Ⅲ型安全有效。     

气囊导尿管用于预防食管闭锁术后吻合口狭窄的效果观察

目的 探讨预防先天性食管闭锁术后并发吻合口狭窄的措施与临床效果.方法 对49例新生儿先天性食管闭锁患儿在手术中预先留置双腔气囊导尿管做食管支架,术后早期做引流,然后做营养管及预防性扩张用,观察预防吻合口狭窄的效果.结果 49例新生儿先天性食管闭锁术后3个月内发生吻合口狭窄6例,发生率12.24%,未增加其他并发症的发生.结论 术中预先留置双腔气囊导尿管用于预防食管闭锁术后吻合口狭窄具有良好的效果,减少第二次手术率,降低了患者费用,提高患儿生存质量.     

食管贲门癌术后严重并发症的诊治体会

对1665例食管贲门癌患，行手术切除1572例，切除率94.4%，手术死亡3例。死亡率0.19%。术后吻合口瘘23例（1.46%)，死亡6例；颈瘘4例开放引流自愈；胸内瘘19例，6例保守治疗，治愈2例，死亡4例，13例再手术，11例治愈，2例死亡，吻合口狭窄发生13例（0.83%)；膜状型6例，经扩张术治愈，环状型2例经纵切横缝治愈，管状型5例中3例行吻合口切除胃食管端端吻合治愈，2例置管，乳糜胸18例（1.15%)；1例胸膜固定法治愈，17例再手术治愈，食管贲门癌术后严重并发症原因是多方面的，但技术熟练，操作规范是减少并发症的关键。并发症的发生需早诊断，早治疗，从而提高治愈率，降低死亡率。     

食管腐蚀性瘢痕狭窄的外科治疗

为了观察食管腐蚀性瘢痕狭窄的外科治疗效果，自1980年至1995年间我们为14例食管腐蚀性瘢痕狭窄病人行结肠移植咽下食管斜切口吻合。结果，吻合口瘘1例，换药2周治愈；吻合口狭窄2例，全组无手术死亡。术后随访10年生存11例，全部进食良好，吞钡检查吻合口正常。我们认为结肠移植咽下食管斜切口吻合治疗食管腐蚀性瘢痕狭窄效果满意。     

结肠或胃代食管术治疗食管腐蚀伤后瘢痕性狭窄

目的总结结肠或胃代食管术治疗食管腐蚀伤后食管瘢痕狭窄的临床经验.方法食管腐蚀伤后食管瘢痕性狭窄患者46例,伤后1～6个月内手术41例,其中3～4个月手术28例;6个月以上5例.采用结肠代食管术43例,胃代食管术3例.结果全组无手术死亡.术后发生颈部吻合口瘘4例,吻合口狭窄2例,腹壁切口裂开1例,均治愈.随访41例,最长随访3年,除2例进软食时有哽噎感外,其余患者均能正常进食.结论采用结肠代食管术治疗食管腐蚀伤后瘢痕狭窄是一种理想的手术方法.     

胸腔镜治疗Ⅲ型食管闭锁30例分析

目的探讨胸腔镜下手术矫治Ⅲ型食管闭锁的疗效。方法回顾性分析我院2013年6月~2016年10月经胸腔镜手术治疗30例Ⅲ型食管闭锁的临床资料。手术年龄1~11 d,平均3.2 d;出生体重1700~3700 g,平均2827.5 g。术前造影检查提示食管近端盲端在T2水平15例,T3~T4水平15例。术前合并肺炎15例(其中4例需呼吸机辅助通气),先天性心脏病17例(其中肺动脉高压3例,永存左上腔静脉1例),肛门闭锁2例。均采用三孔法,在胸腔镜下完成气管食管瘘修补+食管端端吻合术。结果术中证实ⅢA型12例,ⅢB型18例。手术时间100~300 min,平均190 min,术中出血5 ml,无中转开胸手术。29例顺利经胸腔镜一期完成手术;1例33周早产儿因重症肺炎一期仅行胸腔镜下气管食管瘘修补术,延期3周在胸腔镜下完成食管端端吻合术。术后2例放弃治疗死亡,余28例治愈出院。28例术后呼吸机使用时间2~14 d,平均4.2 d。术后住院时间7~30 d,平均15.8 d。28例中术后败血症5例,化脓性脑膜炎2例,均治愈。吻合口漏7例,保守治疗1~3周治愈。28例术后随访3~43个月,平均13.8月。吻合口狭窄11例,扩张2~6次缓解;气管食管瘘复发1例,再次手术修补成功;严重胃食管反流1例,再次腹腔镜下Nissen术。结论胸腔镜治疗Ⅲ型食管闭锁安全,有效,切口美观,能够达到微创效果。     

先天性食管闭锁的外科治疗

目的 总结32例先天性食管闭锁手术治疗经验。方法 手术均采用食管上盲端前壁肌层U形翻转，即经胸膜外入路充分游离食管上端及瘘管，近气管侧缝扎切断瘘管。用剪刀将远端食管前壁纵行剪开5min，吻合前距吻合口上方10min处行食管上下两端浆肌层缝合3针，然后距吻合口上方15～20min处将食管前壁肌层切开，从切开处向吻合口方向从两侧纵行切开肌层至吻合口约5mm，轻轻分离前壁肌瓣，形成U形向下翻转，缝合在食管远端浆肌层上。结果 32例中17例采用此方法未发生吻合口瘘，1例吻合口狭窄。2例成功行一期胃代食管术。结论 食管上盲端前壁肌瓣U形翻转能有效预防吻合口瘘及狭窄。Ⅰ、Ⅱ型食管闭锁采用一期胃代食管术，可避免二次手术。     

58例结肠代食管术治疗食管良性狭窄

目的 总结结肠代食管手术治疗食管良性狭窄的经验及效果.方法 58例中男39例,女19例.年龄16～67岁,平均36岁.先天性食管狭窄2例,创伤性3例,瘢痕性狭窄53例(均为腐蚀剂烧伤).行一期游离空肠,咽空肠吻合术,远端空肠旷置,二期结肠代食管术3例次;胸骨后途径食管结肠颈部端侧吻合转流术56例次.结果 无手术死亡,手术经过较为顺利.术后出现全结肠坏死2例、吻合口瘘7例、吻合口狭窄2例、左喉返神经损伤3例.52例随访1～16年,1级(效果极好)40例、2级(很好)9例、3级(满意)2例、4级(不满意)1例.结论 结肠代食管术是治疗食管良性狭窄较为理想的手术.     

Comparison of anastomotic suturing techniques in the rat esophagus.

BACKGROUND: Long-gap esophageal atresia continues to be a challenging pediatric thoracic surgical problem. Despite the use of various tension relieving procedures, the esophageal anastomosis is often performed under considerable tension. Excessive tension can cause anastomotic sutures to pull through the esophageal tissue, with resultant early esophageal anastomotic dehiscence. To test the hypothesis that interrupted horizontal mattress sutures would withstand the forces of tension better than interrupted simple sutures, an experimental study of rat esophageal anastomoses was done. METHODS: Twenty rats were killed and their esophagi were excised. The esophagi were divided in the mid portion and end-to-end anastomoses were done using interrupted 6-0 polypropylene sutures. Ten rats had anastomoses done with interrupted simple sutures and ten had interrupted horizontal mattress suturing. Anastomotic breaking strength was tested in a tensiometer. RESULTS: Anastomotic breaking strength was 3.22+/-0.56 N for the interrupted simple sutured anastomoses and 3.51+/-0.61 N for the interrupted horizontal mattress group (p=0.30). The difference was not significant. CONCLUSIONS: In this animal study interrupted simple and horizontal mattress suturing withstood the disruptive forces of anastomotic tension equally well.     

Esophageal atresia--a rabbit model to study anastomotic healing and the use of tissue adhesive fibrin sealant

The problem of bringing together two relatively widely separated, small, and fragile ends of a sick newborn baby's atretic esophagus remains a formidable surgical task, wherein the incidence of anastomotic leakage ranges from 10% to 27%. Recently, a multicomponent tissue adhesive fibrin sealant (Tisseel) has been licensed in Canada and declared useful for sealing gastrointestinal (GI) tract anastomoses. To study whether Tisseel might decrease the leakage rate of esophageal anastomoses in neonatal esophageal atresia and perhaps limit stricture formation, a rabbit model of esophageal atresia was developed. Twenty New Zealand white rabbits weighing 2.8 to 3.7 kg underwent thoracotomy and resection of a segment of esophagus with end-to-end, interrupted silk-sutured anastomosis under tension, to mimic the conditions found in newborn esophageal atresia. Four died immediately following operation. Ten rabbits had their anastomosis sealed with Tisseel, six control animals did not. All animals consumed variable amounts of water and food, starting 24 hours after surgery. Survival averaged 10.5 days (range, 5 to 20 days). Eight animals (five experimental, three control) were evaluated by means of barium esophagograms 1 week postoperatively, and all except one control animal demonstrated radiologic evidence of anastomotic leakage. Autopsy specimens revealed gross leakage in nine animals (seven experimental, two control). However, histology revealed leakage and periesophageal abscess formation in all experimental animals and in four control animals. The remaining two controls revealed only some degree of esophageal stenosis. This experiment showed no demonstrable benefit from the use of a fibrin sealant in preventing esophageal anastomotic leakage, such as that which occurs in repaired esophageal atresia.     

EVALUATION OF RISK FACTORS AFFECTING ANASTOMOTIC LEAKAGE AFTER REPAIR OF ESOPHAGEAL ATRESIA

Background:

Anastomotic leak are reported among neonates who underwent esophageal atresia.

Aim:

To find risk factors of anastomotic leakage in patients underwent esophageal repair.

Methods:

All cases with esophageal atresia were included. In this case control study, patients were classified in two groups according to presence or absence of anastomotic leaks. Duration of study was 10 years.

Results:

Sixty-one cases were included. Mean±SD age at time of surgery in patients with leakage and without leakage was 9.50±7.25 and 8.83±6.93 respectively (p=.670). Blood transfusion and two layer anastomosis had significant correlation with anastomotic leakage.

Conclusion:

Blood transfusion and double layer anastomosis are associated with higher rate of anastomotic leakage.     

Prevention of Anastomotic Stricture with a Purse-string Suture Technique on the Gastric Side During Esophageal Carcinoma Operations: Retrospective Study of 463 Consecutive Cases

OBJECTIVE: The objective of this study was to investigate the effect of a gastric side purse-string technique on anastomotic strictures during esophageal carcinoma operations. METHODS: From 1996 to 2005, esophageal carcinoma operations were performed on 1128 consecutive patients. Among them, 463 underwent esophagogastric anastomosis with purse-string sutures on the gastric side (purse group) and the other 665 did not (nonpurse group). Anastomotic strictures, reflux, and leakage were analyzed and compared between the two groups after the operations. RESULTS: Complete follow-up was conducted on all 1128 patients within 6 months after the operation. In contrast to the nonpurse group with a postoperative anastomotic stricture rate of 5.4% (36/665), the purse group demonstrated a significantly lower rate (0.2%, 1/463). The occurrence rates of anastomotic leakage in the nonpurse and purse groups were 0.9% (6/665) and 0.4% (2/463), respectively. Of the 17 cases of gastroesophageal reflux, 15 (15/665, 1.8%) were found in the nonpurse group and 2 (2/463, 1.1%) in the purse group. CONCLUSIONS: Thus, a purse-string suture technique on the gastric side might be an effective method for preventing the occurrence of anastomotic strictures after esophageal resection.     

单层缝合吻合法和吻合器吻合法在低位直肠癌保肛手术中的应用对比研究

目的　探讨单层缝合手法吻合在低位直肠癌保肛手术中的应用价值。方法　 96例我院择期行低位直肠癌保肛手术患者 ,随机双盲分为 2组 ,单层缝合手法吻合组 5 4例 ,以吻合器吻合组4 2例为对照 ,对术后吻合口并发症及患者肛门排便功能进行了对照研究。结果　单层缝合手法吻合组 5 4例无吻合口漏及狭窄。术后排便功能控制好 ,局部复发 2例。吻合器吻合组 4 2例无吻合口漏 ,但 7例发生吻合口狭窄 ,需服用缓泻剂协助排便及扩肛治疗。 2例发生吻合口出血 ,局部复发 2例。结论　单层缝合手法吻合具有操作简便易行 ,经济安全 ,术后并发症少 ,排便功能控制好的优点 ,在低位直肠癌保肛手术中仍占有重要地位     

胸腔镜Ⅲ型食管闭锁矫治的技术改良

目的探讨改良胸腔镜Ⅲ型食管闭锁矫治手术的应用价值。方法回顾性分析2017年6月~2019年3月行改良胸腔镜Ⅲ型食管闭锁矫治23例的临床资料,Ⅲa型9例,Ⅲb型14例;男13例,女10例;体重2.0~3.7 kg,平均2.65 kg;入院年龄5 h^12 d,平均3.5 d。气管插管全麻,双肺通气,左侧俯卧位,采用三孔法(2个孔靠近脊柱,1个孔在腋中线肩胛缘),气胸流量2 L/min,压力<5 mm Hg,术中维持脉搏氧饱和度(SpO 2)>85%。保留奇静脉弓,将其作为支撑把壁层胸膜缝合覆盖食管气管瘘残端;食管吻合在壁层胸膜浅面胸腔内进行,5-0可吸收缝线间断缝合或4-0倒刺可吸收线连续缝合。结果食管闭锁矫治均在胸腔镜下完成,无中转开胸,无输血。1例合并胃穿孔,开腹行胃穿孔修补及置管造瘘。手术时间90~160 min,平均125 min。术后吻合口漏11例,保守治愈10例,1例二次手术治愈。术后随访9~24个月,平均17个月,无食管气管瘘复发,无胃食管反流。术后3个月吻合口狭窄5例,经胃镜下探条扩张治愈。结论将操作孔后移行双肺通气胸腔镜食管闭锁矫治是可行的;保留奇静脉弓作为支撑将壁层胸膜瓣覆盖食管气管瘘残端有利于预防食管气管瘘复发。     

机械吻合在食管外科中的应用：1605例经验总结

１９８０年８月至１９９４年２月应用机械方法对１６０５例食管癌和贲门癌切除后进行吻合。男１２８１例，女３２４例。年龄２８～８１岁，其中５０～６９岁１１８４例（７３．８％）。食管癌１０４４例，贲门癌５６１例。食管胃颈部吻合３５例；超胸顶吻合５８例；弓上吻合８３５例；弓下吻合６７７例。术后发生吻合口瘘１６例（ｌ％），其中颈部吻合口瘘发生率１４．３％（５／３５）；胸内吻合口瘘发生率０．７％（１１／１５７０），前６年胸内吻合口瘘发生率１．４％（８／５７５），近８年胸内吻合口瘘发生率０．３％（３／９９５）。术后发生吻合口狭窄１６例（１％），狭窄明显者经扩张后均恢复正常饮食。作者认为：机械吻合是减少胸内吻合口瘘的有效方法之一。     

A simple technique of oblique anastomosis can prevent stricture formation in primary repair of esophageal atresia

BackgroundAnastomotic stricture is an important problem after esophageal atresia (EA) repair. This study evaluates a technique of oblique esophageal anastomosis without use of a flap in order to prevent stricture formation.MethodsMedical records of 16 patients (14 with EA type III and 2 with EA type IV Ladd-Gross classification) who underwent primary repair of EA at birth without anastomotic tension were reviewed, evaluating long-term follow-up results. All patients were studied with esophageal contrast study, pH-multichannel intraluminal impedance, and endoscopy. The incidence of complications and their management were analysed.ResultsContrast esophagogram and esophagoscopy always showed regular patency of the suture line.ConclusionsOur technique of oblique anastomosis is simple, safe, and effective in preventing stricture formation even in the long-term follow-up.     

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目的 总结吻合环在结肠癌并发肠梗阻行一期切除吻合中的应用经验。方法 回顾性分析1998～2002年间使用吻合环的30例结肠癌并发肠梗阻行一期切除吻合病人的临床资料。结果 全组术中吻合过程均顺利，无手术死亡，术后吻合漏1例(3．3％)，切口感染5例(16．7％)，无吻合口狭窄。结论 吻合环在结肠癌并发肠梗阻手术的应用中具有简单、安全、省时等优点，是提高吻合成功率、减少并发症发生的有效方法之一。     

食管癌贲门癌术后吻合口及胸胃瘘的临床分析

目的　探讨食管癌、贲门癌切除术后吻合口及胸胃瘘发生的高危因素及防治措施。方法　分析 1990年 1月～ 2 0 0 3年 12月间 136 9例行食管癌、贲门癌切除、食管重建术病人的临床资料。结果　本组颈部吻合口瘘的发生率为 16 .2 4 %。胸内吻合口及胃瘘发生率为 2 .0 % ,死亡率2 8.0 % ;前 6年和近 7年相比 ,胸内瘘的发生率为 3.33%对 1.4 6 % (P =0 .0 31)。胸内机械吻合瘘的发生率为 0 .5 1%。结论　吻合口瘘及胸胃瘘是食管重建术后严重的并发症 ,应用机械吻合、熟练掌握手术技巧和加强围术期管理是预防瘘发生的有效方法