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.

Thoraoscopic repairs of congenital esophageal atresia with tracheoesophageal fistula

Objective To evaluate the methods and efficacies of thoracoscopic repairs of congenital esophageal atresia with tracheoesophageal fistula (EATEF) in neonates.Methods A retrospective review was performed for 54 patients undergoing thoracoscopic repairs of esophageal atresia from July 2013 to July 2015.There were 32 boys and 22 girls with a mean age range of 1-12 (5.17 ± 2.32) days and a mean weight range of 2.0-3.79 (2.85 ± 0.44) kg.And 13 type ⅢA and 41 type ⅢB congenital esophageal atresia were diagnosed preoperatively by esophageal scintigraphy.Results Among them,51 patients underwent one-stage thoracoscopic repairs successfully.There were 3 cases of conversion into open thoracotomy.The mean operative duration was 94-208(138 ± 30) min.Two patients underwent fistula ligation due to proximal esophageal fistula.Three cases had esophageal incision due to distal esophageal stenosis.Two patients underwent anastomosis above right aortic arch while complicated with right aortic arch anomaly.Among 9 cases of anastomotic leak,death occurred as a result of treatment withdrawal (n =2) and respiratory failure from severe pneumonia (n =2).There was one case of recurrent esophagus-trachea fistula.Four patients were cured by intravenous nutritional supports.And 49 cases were cured and no complications occurred during a follow-up period of 4-28 months.Five cases of anastomotic stenosis recovered well after esophageal dilatation.Conclusions Thoracoscopy is both safe and effective for EATEF.With better exposure and easier handling,associated esophageal malformation can also be satisfactorily managed.Inclined planar clipping of esophagus and anastomosis reduces the occurrence of anastomosis stenosis.Its outcomes are dependent upon operative experiences and skills.Also anesthetic cooperation is also important.