胸腔镜下先天性食管闭锁手术纠治的初步体会

目的 介绍胸腔镜下工期食管气管瘘管结扎、食管对端吻合治疗新生儿先天性Ⅲ型食管闭锁.方法 收集6例本院2006年6月至2008年12月间经胸腔镜开展的新生儿食管闭锁手术病例,男4例,女2例,年龄2 d～8周,影像学检查证实5例为ⅢB型食管闭锁,1例为ⅢA型食管闭锁.结果 4例在镜下完成瘘管结扎切断、食管吻合手术,2例术中中转开胸.结论 胸腔镜下新生儿ⅢB型食管闭锁瘘管结扎食管吻合是一种可取的手术途径,从已有报告及我们4例随访结果提示,镜下途径对患儿术中打击小,胸壁损伤轻,术后恢复快,微创效果明显,术中能否获得满意的暴露和食管两端的距离是影响手术的重要因素.

Thoracoscopic repair of congenital esophageal atresia in infants

Objective To introduce the thoracoscopic procedure of esophagtytracheal fistula ligation and one-stage esophageal anastomosis for neonatal esophageal atresia.Methods From Jun 2006 to Dec 2008,thoracoscopic procedures of fistula ligation and one-stage esophageal anastomosis were performed on 6 neonates with congenital esophageal atresia in our institutions.There were 4 boys and 2 girls,with the age from 2 days to 8 weeks.In all the cases,5 were diagnosed as the esophageal atresia type ⅢB,while the other one as type ⅢA.Results Four cases underwent the thoracoscopic procedure of esophago-tracheal fistula ligation and one-stage esophageal anastomosis.Diverted thoracotomy was performed on 2 cases.Conclusions The thoracoscopic procedure of esophago-tracheal fistula ligation and one-stage esophageal anastomosis is an acceptable procedure for patients with type ⅢB esophageal atresia.From reported cases by others and 4 cases in our following-up,we conclude that less intra-operative threatening,fewer lesions of thoracic wall,earlier postoperative recovery and more minimal invasion can be gained from the thoracoscopic procedure.Satisfactory anatomic exposure and the distance between two ends of esophagus are the crucial factors which may affect the surgical effects.