Type A esophageal atresia: a critical review of management strategies at a single center

Purpose

The purpose of was to study the short- and long-term outcomes in the management of isolated esophageal atresia with different operative strategies.

Methods

All patients undergoing type A atresia repair over a 15-year period were included. Demographic data, birth weight, gestational age, incidence of associated anomalies, management, and long-term outcomes were studied.

Results

Fifteen patients with type A atresia (9 male) were treated in the study period. The mean gestational age was 35.5 weeks (range, 27-39 weeks), and the mean birth weight was 2179 g (range, 670-3520 g). Eight babies had associated anomalies. Thirteen patients underwent gastrostomy as the initial procedure, and 2 underwent the Foker procedure. In the delayed management group, 9 patients underwent primary anastomosis, with 2 patients needing proximal pouch myotomy. Two patients underwent a Collis gastroplasty. Two patients underwent a cervical esophagostomy and a gastric tube replacement at 4 months and 1 year, respectively. Eight patients (60%) in this group had anastomotic leaks. All patients are currently on prokinetics and proton pump inhibitors. Seven required antireflux surgery. The median length of hospital admission was 4 months (range, 3-19 months). The native esophagus was preserved in 13 (85%) of 15 babies. All patients are alive, and 14 of 15 are capable of feeding orally.

Conclusions

Type A esophageal atresia continues to be associated with significant morbidity despite advances in surgical technique and intensive care.     

Investigating the use of preoperative nasogastric tubes and postoperative outcomes for infants with pyloric stenosis: a retrospective cohort study

Purpose

Literature is lacking regarding the role of nasogastric tubes in patients with pyloric stenosis. There is also no consensus among surgeons. Some believe that pyloric stenosis is a form of gastric outlet obstruction, and the stomach should be drained until the obstruction is relieved. Others claim that infants can handle their secretions, and draining the stomach may further exacerbate the alkalosis. This chart review examines the use of preoperative nasogastric tubes in a single pediatric institution and its effect on vomiting rates and length of stay.

Methods

After research ethics board approval, a retrospective review was performed on 109 patients admitted between January 1, 2007, and December 31, 2008, with pyloric stenosis who underwent pyloromyotomy. Data were collected on presence of a preoperative nasogastric tube, preoperative electrolyte levels, ultrasound characteristics, episodes of postoperative vomiting, and length of stay.

Results

One hundred six patients were used in the final analysis. A nasogastric tube was placed in 77 patients (73%). Patients with a preoperative nasogastric tube had significantly higher episodes of postoperative vomiting (P = .015; 95% confidence interval [CI] 0.29-2.63) and length of stay (P = .017; 95% CI, 2.49-25.01). Bicarbonate levels were also significantly higher in patients with a nasogastric tube. There was no difference in the duration of symptoms, ultrasound characteristics, or type of operation between the 2 cohorts.

Conclusion

The data strongly suggest that preoperative nasogastric tube placement adversely affects postoperative vomiting and consequently increases length of stay. The lack of consensus about the use of preoperative nasogastric tubes coupled with these findings indicates the need to evaluate this practice with a prospective randomized controlled trial.     

纤维支气管镜判断三种方法联合应用于双腔支气管导管就位的准确率

目的以纤维支气管镜（FOB）判断联合应用听诊法、气道压力变化法及PETCO2波形法在双腔支气管导管（DLT）就位的准确率。方法选择胸科麻醉手术患者60例,静脉诱导后插入RobertshawDLT。通过三种方法联合应用调整导管位置达到标准后用FOB判断RobertshawDLT就位的准确率。结果平卧位时,DLT就位满意率为95%;侧卧位后,DLT就位满意率为93.4%。结论三种方法联合应用明显提高DLT就位满意率,但FOB仍是确定DLT位置的金标准。     

左侧开胸术时主导管位置听诊法用于Univent导管的定位

目的评价主导管位置听诊法用于Univent导管定位的效果。方法60例ASAⅠ或Ⅱ级的患者,随机均分为三组,纤维支气管镜(FOB)组、主导管位置听诊(FS)组、推荐法插管(RIT)组。记录插管时间、堵塞导管试插的次数(FOB组除外)、主导管到隆突的距离、堵塞气囊充气量和位置分级、术中单肺通气时间,术毕检查气管黏膜损伤情况并评分。结果FS组堵塞导管均一次插入左侧,RIT组25%一次插入左侧。FS组插管时间比FOB组和RIT组短(P<0.05)。RIT组堵塞气囊充气量比FS组多,堵塞气囊位置评分比FOB组高(P<0.05)。黏膜损伤三组差异无统计学意义。结论FS法Univent导管定位较快速、准确,RIT法定位准确性较差,易出现过深、过浅的问题。     

管扎式结肠肛管吻合术治疗低位直肠癌(附256例报告)

目的:评价管扎式结肠肛管吻合术治疗低位直肠癌的安全性和临床效果.方法:回顾性分析1991年10月至2005年12月共256例低位直肠癌行管扎式结肠肛管吻合术的临床资料.结果:无手术死亡,术后发生吻合漏1例,吻合口狭窄16例,术后肛门功能优良率96.7%,术后5年肿瘤局部复发13.1%,5年存活率为71.9%.结论:该法具有操作简单易行安全可靠,减少了吻合口漏的发生,适用于各级医院开展.     

小肠内固定术治疗粘连性肠梗阻

目的评价小肠内固定术治疗粘连性肠梗阻的疗效。方法回顾性分析28例粘连性肠梗阻行小肠内固定术患者的临床资料。结果28例患者中有5例发生切口感染,无手术死亡和小肠瘘发生。其中25例患者平均随访23.6个月,1例肠梗阻复发,保守治疗后好转。结论小肠内固定术是治疗预防粘连性肠梗阻可行、有效的方法,但需要注意手术操作细节。     

肠梗阻导管在腹部术后早期炎性肠梗阻治疗中的应用

目的探讨经鼻型肠梗阻导管在腹部术后早期炎性肠梗阻治疗中的作用。方法对我院2004年6月至2006年6月期间40例腹部术后早期炎性肠梗阻患者,随机分成经鼻型肠梗阻导管组和鼻胃管组。观察腹胀改善情况(腹围)、胃肠减压量、腹部X线平片、气液平面消失时间等指标,对结果进行分析比较。结果经鼻型肠梗阻导管组患者的胃肠减压量(1021.2±265.4)ml/d较鼻胃管组(642.5±325.4)ml/d明显增多,且腹围(15.2±5.5)cm减少较鼻胃管组的(5.7±3.6)cm更明显,气液平面消失时间(10.3±8.5)d较鼻胃管组的(15.6±11.7)d明显缩短,差异有统计学意义(P<0.05)。结论经鼻型肠梗阻导管能更有效胃肠减压,减轻腹胀,促进肠蠕动,治疗腹部术后早期炎性肠梗阻作用显著。     

Laparoscopic primary choledochorrhaphy over endonasobiliary drainage tubes

Background The T-tube is widely used in laparoscopic choledochotomy to decompress the biliary tree. However, there are high morbidity rates related to the T-tube. This study reviewed the results of laparoscopic primary choledochorrhaphy over endonasobiliary drainage (ENBD) tubes to find an effective alternative to the T-tube for the performance of laparoscopic choledochotomy. Methods From March 2003 to September 2005, 23 patients (9 men and 14 women) with choledocholithiasis underwent laparoscopic choledochotomy over ENBD tubes. The mean age of these patients was 47 years (range, 32–73 years). At admission, six patients had cholangitis. All the patients had ENBD tubes placed preoperatively after the failure of endoscopic sphincterotomy. Results There was no conversion to open surgery. The mean operative time was 90 min (range, 70–150 min). There were no biliary complications such as bile leaks, biliary peritonitis, or pancreatitis. No residual stones were found by postoperative cholangiograms. The ENBD tubes were removed between postoperative days 7 and 9. The hospital stay ranged from 8 to 14 days, with 16 patients (70%) discharged on postoperative day 8. The complications were limited to one umbilical infection and one case of pneumonia. The median follow-up period was 24 months (range, 8–36 months), and none of the patients were readmitted with biliary symptoms. Conclusion Laparoscopic choledochotomy over ENBD tubes proved to be technically feasible and safe. The ENBD tube decompresses the biliary tree and allows for cholangiography after surgery. Its removal does not need to wait for tract maturation, which allows an earlier removal of the tube and a shorter postoperative hospital stay. Laparoscopic choledochotomy over ENBD tubes is an effective alternative to the T-tube in laparoscopic choledochotomy.     

食管癌术后经鼻肠管注入中药促进胃肠功能恢复研究

目的 促进食管癌术后患者胃肠功能的恢复.方法 将60例食管癌术后患者随机分为观察组和对照组各30例,对照组经鼻肠管内注入肠内营养液后注入100 ml生理盐水;观察组经鼻肠管内注入肠内营养液后注入150 ml自制中药,1次/d,连续3 d后评价效果.结果 观察组术后首次肛门排气、排便及肠鸣音恢复时间显著早于对照组,血浆胃...     

视频喉镜引导困难气管插管的护理配合

对69例气管插管困难患者在视频喉镜引导下气管插管成功,无一例因护理配合不当出现并发症。提出术前做好用物准备,对患者气管插管困难进行预测及判断患者有无寰椎关节运动受限或张口异常,针对性做好应对措施;术中熟练操作步骤,密切配合,加强生命体征观察,可提高气管插管成功率、减少损伤、增加安全性。