食管闭锁术后食管气管瘘复发再手术的临床分析

目的：分析食管闭锁（EA）术后食管气管瘘复发（RTEF）再手术的临床资料,总结RTEF的原因、诊断方法及再手术的经验。方法回顾性分析2005年1月至2013年12月我们收治的10例EA术后RTEF患儿的临床资料,其中男7例,女3例,再手术平均年龄为19个月,平均体重为8.3kg,所有病例均为GrossⅢ型;10例中有9例曾接受经右胸食管气管瘘结扎＋食管端端吻合术。结果在初次手术中有4例（4/10）瘘管并未切断。9例（9/10）复发瘘管的食管端开口于原食管吻合口狭窄处或近端食管。8例（8/10）术后存在不同程度吻合口狭窄,1例合并吻合口瘘。再手术前所有患儿行食管欧乃派克造影检查,确诊和疑似RTEF分别为5例（5/10,50％）、4例（4/10,40％）。所有RTEF通过胃镜及支气管镜确诊（10/10,100％）。患儿均接受再次进胸手术,平均手术时间3.2h,平均术后住院时间为15.8d。术后均获随访3～96个月,食管造影提示所有病例均治愈,未再发生RTEF。结论 EA术后RTEF与初次手术瘘管处理不当、食管吻合口局部炎症反应等因素有关,需再次手术治疗,再手术的疗效及患儿预后良好。     

Re-operation after the primary repair for patients with esophageal atresia

目的 分析总结食管闭锁术后食管再手术的临床经验.方法 2005年6月至2011年7月,8例接受食管闭锁术后食管再手术患儿,男6例,女2例.再手术时年龄6～52个月.7例GrossⅢ型,1例Gross Ⅰ型.再手术前表现为进食后呛咳及进食困难.6例食管气管瘘复发,2例严重狭窄反复扩张无效.8例行食管造影和食管镜检查瘘管及狭窄情况;4例行支气管镜检查.6例术中单肺通气.8例经右胸再手术,切断、缝扎食管气管瘘管,切除狭窄段食管并端端吻合.结果 平均手术时间3～3.5 h.平均住院时间25 d.随访1～72个月,无患儿发生吻合口瘘和食管气管瘘再复发.1例患儿吻合口狭窄扩张1次.结论 食管气管瘘复发多与瘘管未切断及局部炎症有关;食管狭窄与吻合张力高及吻合口漏相关.食管气管瘘复发或/和严重吻合口狭窄是食管再手术的指征.食管镜、支气管镜联合运用,有助于食管气管瘘管复发的诊断和术中定位.单肺通气为再手术提供相对安全的麻醉方式.食管再手术后恢复良好.     

先天性食管闭锁／食管气管瘘合并食管狭窄的治疗分析

目的探讨先天性食管狭窄并食管气管瘘／食管闭锁的临床特征、分型及治疗方法,以减少误诊误治。方法通过2例先天性食管狭窄并食管气管瘘／食管闭锁患儿的病例报告,分析影像学资料及临床分型、随访结果。结果1例患儿在食管闭锁手术中得到了确诊并切除了隔膜,术后接受了食管扩张术;1例患儿术后造影发现了食管狭窄,仅行保守治疗。2例患儿随访效果良好。结论食管闭锁手术中有必要对远端食管进行探查,排除合并食管狭窄畸形。     

胸腔镜下一期手术治疗食管闭锁合并气管软化的短期疗效

目的评估胸腔镜下一期气管后壁悬吊术联合食管端端吻合术治疗食管闭锁合并气管软化的有效性及安全性。方法本研究为回顾性研究。以2018年1月至2020年1月湖南省儿童医院新生儿外科收治的11例食管闭锁合并中度(气管软化评分在81%～90%)或重度(气管软化评分在91%～100%)气管软化的患儿为研究对象, 患儿均在胸腔镜下行气管后壁悬吊术联合食管端端吻合术治疗。收集所有患儿术后呼吸机通气时间、围手术期并发症以及短期随诊结局, 进而评估气管后壁悬吊术联合食管端端吻合术治疗食管闭锁合并气管软化的有效性和安全性。结果 11例均在胸腔镜下完成气管后壁悬吊术联合食管端端吻合术, 无一例中转开胸病例。术中气管悬吊固定时间为7(5～8)min, 无一例气管损伤发生。术后气管插管呼吸机辅助通气时间为65(15～189)h。2例出现食管瘘, 均经保守治疗愈合, 其中1例出现食管狭窄, 行球囊扩张后缓解。随访12(10～15)个月, 1例反复出现呼吸困难、呼吸道感染, 经多次住院治疗, 1年后逐渐好转。结论胸腔镜下气管后壁悬吊能在解剖上改善气管软化, 缩短术后呼吸机辅助通气时间, 预防气管软化症的发生, 手术时...     

先天性食管闭锁并食管气管瘘胸腔镜手术探讨

目的 探讨胸腔镜下手术治疗先天性食管闭锁并食管气管瘘的方法和疗效.方法 回顾性分析本院2013年7月至2015年7月间经胸腔镜手术治疗54例先天性食管闭锁患儿的病例资料.其中男32例,女22例,患儿年龄1～12d,平均(5.17±2.32)d,患儿体重2.0～3.8kg,平均(2.85±0.44) kg.术前通过食管造影检查诊断先天性食管闭锁ⅢA型13例,ⅢB型41例.结果 51例患儿在胸腔镜下完成食管气管瘘结扎切断、食管端端吻合术,手术时间94～208min,平均(138±30) min.3例患儿中转开胸手术.2例患儿术中发现近端也合并有食管气管瘘,同时行近端瘘管结扎.3例患儿发现远端合并食管狭窄,术中同时行食管狭窄切开术.2例患儿术中发现合并右位主动脉弓畸形,行主动脉弓前食管吻合.2例患儿游离近端食管时气管破裂,予5-0可吸收线缝合修补治愈.术后9例发生吻合口漏,其中2例放弃治疗,2例因重症肺炎并呼吸衰竭死亡,1例食管气管瘘复发失访,其余4例患儿通过静脉营养支持治疗治愈.49例患儿治愈出院并获得随访4～28个月.5例患儿出现食管狭窄,在胃镜下行食管扩张治愈出院.结论 胸腔镜下手术治疗新生儿Ⅲ型先天性食管闭锁是一种安全有效的手术途径;术中视野清晰,手术操作方便,能同时处理合并的其他食管畸形;食管斜面裁剪食管吻合可降低术后食管狭窄的发生.胸腔镜下食管闭锁手术的疗效需要术者具备丰富的手术经验和娴熟的腔镜操作技术,麻醉的配合是手术顺利进行的重要因素.     

胸腔镜在Ⅲ型食管闭锁合并气管食管瘘修补术中的应用研究

目的探讨胸腔镜在Ⅲ型食管闭锁合并气管食管瘘修补术中的应用价值。方法回顾性分析2015年6月至2018年1月采用胸腔镜手术治疗的22例Ⅲ型食管闭锁合并食管气管瘘患儿临床资料,其中男性12例,女性10例;手术年龄2~9 d,平均手术年龄(4.27±1.81)d,体质量1.5~4.05 kg,平均体质量(2.44±0.68)kg。术前均经胸片和上消化道造影明确诊断,均在电视胸腔镜下行食管气管瘘修补及食管吻合术。结果 22例中,除1例中转开胸手术以外,其余病例均在胸腔镜下顺利完成手术;平均手术时间142.3(118~165)min,术后平均住院时间15.41(8~22)d,第一次经口喂养时间平均3.78(3~5)d,平均呼吸机通气时间26.54(9~52)h。术后有8例因吻合口狭窄行胃镜下食管球囊扩张术;2例出现吻合口瘘,1例予延长禁食时间,持续胃肠减压1周后好转,1例家属放弃治疗。除放弃治疗病例外,21例获随访1个月至2年,随访中1例术后1个月出现食管气管瘘经再次手术治愈;5例随访有吻合口狭窄,经1~4次球囊扩张后改善,现无明显吞咽困难;2例有胃食管反流,现保守治疗中;1例气管稍狭窄,现观察中;其余患儿生长发育良好。结论随着新生儿麻醉及手术技术的不断提高,胸腔镜下手术成为Ⅲ型食管闭锁合并气管食管瘘患儿首选的手术方案。     

小儿气管支气管软化症70例临床分析

目的 探讨小儿气管支气管软化症的病因和诊治方法.方法 对2007年6月至2010年6月我院诊断的70例气管支气管软化症患儿的临床资料进行回顾性分析.结果 在70例患儿中,合并心血管畸形53例(75.7％)、食管气管瘘4例(5.7％)、食道闭锁1例(7.2％);单纯气管支气管软化症12例(17.2％).所有患儿均经CT气道重建和纤维支气管镜检查确诊,发现左主支气管狭窄49例,右主支气管狭窄7例,双侧狭窄8例,气道狭窄6例;轻度软化21例,中度软化39例,重度软化10例.所有患儿均给予对症治疗,合并先天性畸形的患儿给予手术治疗.55例好转出院,5例因重症肺炎难以治愈出院,4例死亡,6例无手术指征自动出院.结论 通过CT气道重建可以发现小儿气管支气管狭窄部位,纤维支气管镜检查可提高气管支气管软化症的确诊率.合并有先天性心脏病或食道病变的患儿应尽早手术改善其临床症状.     

小儿食管化学烧伤瘢痕狭窄的外科治疗

目的　探讨小儿食管化学烧伤瘢痕狭窄的外科治疗经验。方法　本组 42例均采用横结肠代食管、保留结肠左动脉升支、胸骨后顺蠕动吻合 ,其中横结肠咽腔吻合 1 3例 ,横结肠食管颈部吻合 2 9例。结果　手术后颈部吻合口瘘 3例、吻合口狭窄 2例、气管切开 2例 ,经治疗后痊愈 ,无手术死亡。 30例随访 2～ 2 4年 ,患儿发育正常。结论　小儿食管化学烧伤瘢痕狭窄应积极采取胸骨后横结肠代食管 ,同期食管瘢痕切除危险性大 ,以食管旷置为佳 ,重建平面应在颈部或咽部。     

胸腔镜与开胸手术治疗先天性食管闭锁并食管气管瘘的对比研究

目的 比较胸腔镜手术与开胸手术治疗先天性食管闭锁并食管气管瘘的疗效差异.方法 回顾性分析50例Ⅲ型先天性食管闭锁并食管气管瘘的临床资料,其中25例为江西省儿童医院2012年12月至2014年1月收治,采用胸腔镜治疗;另25例为首都儿科研究所2008年6月至2014年4月收治,采用开胸治疗.男27例,女23例,术前均明确诊断并完成手术治疗.胸腔镜组采用3孔法,经胸行食管气管瘘结扎,食管吻合术.开胸组采用经胸膜外完成手术.结果 胸腔镜组25例均一期完成食管吻合术,无中转,术后2例死亡.开胸组25例中23例完成经胸膜外食管吻合术,2例因食管盲端距离过长行食管气管瘘结扎,胃造瘘术,术后放弃治疗.手术时间胸腔镜组平均为127min(110～160min),开放组平均133min(105～170min);呼吸机使用时间胸腔镜组平均为2.6 d(1～13 d),开放组平均2.3 d(1～11 d),两组对比差异均无统计学意义.胸腔镜组25例中2例吻合口漏(8％),7例狭窄(28％),2例食管气食管瘘复发(8％).开放组25例中2例吻合口漏(8％),4例狭窄(16％),无食管气管瘘复发,两组比较差异均无统计学意义.结论 胸腔镜手术治疗先天性食管闭锁并食管气管瘘是安全可行的,但要求术者具备熟练的微创手术技术和相关的手术技巧.     

先天性食管闭锁和气管食管瘘疗效探讨

目的探讨先天性食管闭锁和气管食管瘘的治疗效果。方法对1994年1月-2006年12月治疗的107例先天性食管闭锁和气管食管瘘进行了回顾分析。结果成活85例,成活率为79.44%;放弃治疗13例,死亡9例,死亡率8.41%;术后发生吻合口瘘29例,吻合口狭窄4例。结论提高食管闭锁和气管食管瘘患儿成活率的关键是早期诊断,减少吻合口瘘的发生。     

先天性食管闭锁及气管食管瘘11例

目的探讨先天性食管闭锁及气管食管瘘的早期诊断和治疗方法。方法先天性食管闭锁患儿11例均在入院24h内行食管泛影葡胺或碘化油造影确诊,并经胸膜外入路行食管吻合术,分析总结其诊断和治疗。结果治愈9例(81.8%),死亡2例(18.2%)。1例术后有食管吻合口狭窄,行食管扩张术后治愈;1例术后吻合口瘘,经抗感染、营养支持、充分引流后瘘口愈合。结论早期诊断、及时手术、术后护理及并发症的防治对提高先天性食管闭锁患儿的存活率有重要作用。     

Novel technique of repair of large tracheo-esophageal fistula following battery ingestion in children: review of two cases

Surgical repair of acquired tracheo-esophageal fistula may result in tracheal stenosis or esophageal stricture. We used fistula with esophageal cuff as flap to repair the tracheal defect. Esophageal repair was performed by rotating ends through 90° in opposite direction. This technique offers excellent repair in a single stage.     

Congenital esophageal stenosis associated with tracheoesophageal fistula

Two patients with congenital esophageal stenosis associated with an H-type tracheoesophageal fistula in one and esophageal atresia with distal fistula in the other are presented. In both patients the correct preoperative diagnosis was made by esophagram. Satisfactory results were obtained with surgical excision. Histologic studies revealed fibromuscular stenosis and membranous esophageal mucosa, respectively.     

Costal cartilage grafting for repair of a recurrent tracheoesophageal fistula in a 1.6-kg baby with esophageal atresia

 A large intraoperative tracheal tear occurred during correction of a type III esophageal atresia in a 1,630-g premature baby. It was repaired by primary suture. Recurrence of the tracheoesophageal fistula (TEF) was treated operatively with esophageal exclusion and costal cartilage grafting (CCG) onto the tracheal defect. At 3 months of age, successful esophageal reconstruction was performed using a posterior mediastinal colonic interposition. On 27-month follow-up, the child was symptom-free and thriving. Surgical options for TEF recurrence and intraoperative management of the tracheal air leak are discussed. CCG is advocated as an attractive material for tracheal repair even in low-weight prematures. Accepted: 30 April 2001     

Antenatal treatment of congenital diaphragmatic hernia: an update]

Despite advances in neonatal care, the associated mortality in isolated congenital diaphragmatic hernia remains in the order of 30%. Death is mainly due to consecutive pulmonary hypoplasia and severe associated pulmonary hypertension. This statement led to the implement of fetal therapy in order to improve fetal lung development. The first phase of fetal surgery consisted in open repair with one-stage surgical correction of the anatomic defect. It was followed by tracheal occlusion technique based on the decrease egress of lung fluid in order to improve lung growth. Initial approach of tracheal occlusion used clips on the trachea. It is now performed with intra-tracheal inflatable balloon. The challenge of such prenatal treatment is to establish accurate prenatal prognosis factors in order to offer this therapeutic in the subgroup of patients in whom outcome of postnatal treatment remains dismal. Current factors used for prenatal prognosis evaluation are thoracic liver position and lung-to-head ratio (LHR). The balloon is inserted at 26 to 28 weeks and removed at 34 weeks. First results are encouraging. However, many patients developed premature prelabour rupture of the membrane and paediatric data are sparse. Only few patients were currently treated and long term evaluation is needed. A powered multicentric study is needed to determine the value of fetal tracheal occlusion in the management of fetuses with isolated severe congenital diaphragmatic hernia.     

胸腔镜治疗先天性食管闭锁

目的 阐述胸腔镜治疗先天性食管闭锁的经验体会.方法 回顾性分析了2006年8月至2011年5月期间共进行11例胸腔镜下食管闭锁手术,采用Styker公司的胸腔镜器械,进行胸腔镜手术操作,患儿年龄为3 d～2个月,男7例,女4例,体重2.1～3.6kg.术前均作碘油造影及胸腹部摄片,证实为食管闭锁,1例1型,10例为Ⅲ型,其中8例伴有先天性心脏病.结果 3例转为开胸,其中2例因手术野影响,另1例为术中出血;7例均在胸腔镜下Ⅰ期完成手术;1例采用胸腔镜分期手术.术中出血少,术后恢复平稳,有2例发生吻合口漏,经保守治疗后恢复好.术后7例作食管扩张各一次.结论 胸腔镜下食管闭锁手术有一定的优越性,但需要掌握一定的适应证,同时要求手术者有较熟练的腔镜技术,患儿的选择和手术者的技术是保证手术成功的关键.     

Isolated longitudinal rupture of the posterior tracheal wall following blunt neck trauma.

The authors report 3 female children (4, 5 and 12 years old) who suffered an isolated rupture of the posterior tracheal wall (membranous part) following a minimal blunt trauma of the neck. Such tracheal ruptures often cause a mediastinal and a cutaneous thoraco-cervical emphysema, and can also be combined with a pneumothorax. The following diagnostic steps are necessary: X-ray and CT of the chest, tracheo-bronchoscopy and esophagoscopy. The most important examination is the tracheo-bronchoscopy to visualize especially the posterior wall of the trachea. Proper treatment of an isolated rupture of the posterior tracheal wall requires knowledge about the injury mechanisms. The decision concerning conservative treatment or a surgical intervention is discussed. In our 3 patients we chose the conservative approach for the following reasons: 1) The lesions of the posterior tracheal wall were relatively small (1 cm, 1.5 cm, 3 cm) and showed a good adaptation of the wound margins. 2) No cases showed an associated injury of the esophageal wall. All of our patients had an uneventful recovery, the lesion healed within 10 to 14 days, and follow-up showed no late complications.     

新生儿梨状窝瘘的诊治特点

目的 阐述新生儿梨状窝瘘这一少见疾病的诊治特点.方法 收集我院2001年7月至2010年1月收治的9例新生儿梨状窝瘘病例,分析其发病年龄、临床表现、辅助检查及临床治疗经过,总结其诊治特点和预后.结果 9例梨状窝瘘均为左侧.均以颈部囊性肿块就诊.8例为新生儿时期出现症状,1例为产前发现.5例颈部增强CT提示肿块中含有气体.新生儿时期手术治疗7例.随访时间6个月至9年,患儿临床均无反复感染或复发迹象.结论 新生儿的梨状窝瘘临床表现不同于儿童,常因颈部无痛性、囊性肿块就诊,缺少反复脓肿切开引流史.超声或CT检查中常可发现囊肿中含有气体影.新生儿早期手术瘘管结扎率高,部分需要胃镜辅助.治疗安全性可靠,术后复发率低且预后良好.     

Isolated congenital tracheal stenosis in a preterm newborn

Severe tracheal stenosis, resulting in functional atresia of the trachea is a rare congenital malformation with an estimated occurrence of two in 100,000 newborns. If no esophagotracheal fistula is present to allow for spontaneous breathing, this condition is usually fatal. We report on a male infant born at 32 weeks of gestation. The patient presented with respiratory distress immediately after delivery due to severe congenital tracheal stenosis resulting in functional atresia of the trachea. Endotracheal intubation failed and even emergency tracheotomy did not allow ventilation of the patient lungs. The patient finally succumbed to prolonged hypoxia due to functional tracheal atresia. The etiology of tracheal atresia and tracheal stenosis is still unclear, but both conditions are frequently combined with other anomalies of the VACTERL (vertebral anomalies, anal atresia, cardiovascular anomalies, tracheoesophageal fistula, esophageal atresia, renal/radial anomalies and limb defects) and TACRD (tracheal agenesis, cardiac, renal and duodenal malformations) association. Conclusion Successful treatment of severe congenital tracheal stenosis and tracheal atresia depends on either prenatal diagnosis or recognition of this condition immediately after birth to perform tracheotomy without delay. Nevertheless, despite any efforts, the therapeutical results of severe tracheal stenosis and tracheal atresia are still unsatisfactory.     

The trachea and esophagus after repair of esophageal atresia and distal fistula: Computed tomographic observations

Five patients, whose espphageal atresia and distal tracheoesophageal fistula had been repaired in infancy, were examined by computed tomography at age 2 to 21 because of recurrent or persistent tracheal or esophageal problems. Their tracheas generally failed to have the roughly circular cross-sectional shape found in controls. The pars membranacea was often unusually broad, with much more section-to-section variation in area than in controls. Change in cross-sectional area with respiratory phase, in the one patient assessed, was much greater than in a control. These tracheal abnormalities help to explain the tracheal symptoms found in these and simular patients. Their esophagi contained much air and fluid.Presented at the annual meeting of the Society for Pediatric Radiology, San Diego, CA, April 1988