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.

Thoracoscopic versus open repair of tracheoesophageal fistula and esophageal atresia

Objective To evaluate the efficacy and safety of tboracoscopic versus open techniques for esophageal atresia (EA) and tracheoesophageal fistula (TEF).Methods A retrospective review was performed for 50 type-m EA/TEF patients.Twenty-five patients underwent thoracoscope from December 2012 to January 2014 at Jiangxi Children's Hospital while another 25 patients had traditional repair through thoracotomy from June 2008 to April 2014 at Capital Institute of Pediatrics.Definite diagnosis and complete operation were accomplished for 27 males and 23 females.The group of thoracoscope underwent a ligation of tracheoesophageal fistula and end-to-end esophageal anastomosis via 3 trocars while another group was operated through an extra-pleural approach.Results Thoracoscope was completed in 25 cases and there were 2 postoperative deaths.And 23 cases underwent extra-pleural esophageal anastomosis and another 2 had a ligation of tracheoesophageal fistula and gastrostomy because of excessively long gaps and 2 cases abandoned postoperative treatment.The mean operative duration was 127 (110 160) min for thoracoscopic approach versus 133 (105 170) rmin for thoracotomy.The mean time to extubation was 2.6 (1 13) versus 2.3 (1 11) days.There were no statistical significance.The anastomotic leak rate was both at 8％ in two groups.The stricture rate was 28％ versus 16％ for closed and open techniques respectively.The relapse rate of TEF was 8％ in thoracoscopic group while none in open group.There was no statistical significance.Conclusions The thoracoscopic technique is safe and feasible for both EA and TEF.However,surgeons must learn the mini-invasive techniques and acquire the relevant ooerative skills.