41例Ⅲ型先天性食管闭锁Ⅰ期手术治疗

目的 探讨先天性食管闭锁Ⅰ期根治手术治疗的效果.方法 1994年11月至2008年6月收治先天性食管闭锁113例,其中接受Ⅰ期根治术41例,均为Ⅲ型,其中B型38例,A型3例.手术治疗率36.28%(41/113例).手术先行胃造瘘术,后行食管闭锁根治术.结果 术后近、远期死亡6例,死亡率14.63%(6/41例).长期生存35例.2007年以后手术12例全部生存.术后常见并发症包括吻合口狭窄、吻合口瘘.吻合口狭窄行食管扩张术治愈.吻合口瘘5例,放弃治疗死亡2例,再次手术2例,保守治愈1例.结论 手术治疗先天性食管闭锁疗效肯定,吻合口瘘是死亡高风险因子,但不是决定因素.提高手术疗效的关键在于早诊早冶,加强围术期监护.

Experience of treatment of 113 cases with congenital esophageal atresia

Objective To evaluate the outcome of patients with congenital esophageal atresia. Methods The medical records of 113 patients with congenital esophageal atresia were reviewed, 41 were identified with type Ⅲ and underwent one-stage operation. The ratio of surgery treatment in all patients was 36.28%. Among them, 38 patients (92.68% ) had type Ⅲ B and 3 patients (7.32% ) had type ⅢA. Gastrostomy was done at first. Then the baby was positioned left recumbent position. Right posterial-lateral incision was made. The azygous vein was ligated and cut. The esophageal tracheal fistula was dissected, cut and sutured by interrupted suture with 5-0 prolene. The thoracic segments of the esophagus were dissected. End to end anastomosis was done by interrupted suture with 5-0 prolene. 2 to 4 relaxation suture of adventitia of esophagus and medias-tinal pleura were done. Thoracic space drainage tube was localized through next costal space, the tip was lay nearby the anastomosis. The neonates were monitored in the neonate ICU. Results Six of the 41 patients died after operation, with a mortality rate of 14.63%. The other 35 patients survived (85.37% ). Twelve cases that operated after 2007 were all survived after operation. Anastomotic striction and anastomotic leakage were the most common postoperative complications, 41. 46% and 12.20% .respectively. Two cases of anastomotic leakage died, 2 cases who were redone esophageal anastomosis survived, 1 case recovered under expectant treatment. Conclusion The outcome of one-stage repair of esophageal atresia is inspiring. Anastomotic leakage is a high-risk factor lead to death, but it is not the determinant factor. The important thing to improve outcome of one-stage repairmen of esophageal atresia depends on early diagnosis, early operation and better management preopera-tive and postoperative.