食管闭锁患儿术后远期并发症及食管功能评价

目的 分析食管吻合术远期并发症及评价食管功能.方法 本研究追踪随访了1990～2007年间27例在新生儿期接受Ⅰ期食管端端吻合术的患儿.观察记录其出院后存在的并发症,包括:生长发育、进食吞咽困难、呼吸系统感染.通过应用食管造影、24h pH监测、24h食管测压手段对食管功能进行分析和评价.结果 平均随访时间(53.1±45.2)个月,48.1%患儿无临床不适表现,48.2%出现远期食管狭窄征象,同时伴有不同程度吞咽困难,22.2%食管狭窄伴严重进食困难者接受食管扩张.22.2%有病理性反流,食管测压结果显示70.3%有食管运动障碍,其中1/3不伴有吞咽困难症状.结论 吻合口狭窄、GER、食管运动障碍、呼吸系统感染等远期并发症基本上不影响患儿的正常生长发育和日常生活,严重的吻合口狭窄行食管扩张术后可以缓解.

Evaluation of late complications and esophageal function in patients with esophageal atresia treated by esophageal anastomosis

Objective To evaluate late complications and esophageal function in patients with esophageal atresia(EA)treated by esophageal anastomosis.Methods Between 1990 and 2007,twenty-seven cases of patients with EA treated at birth by stage Ⅰ esophageal end-to-end anastomosis were followed up.Late complications(such as growth retardation,dysphagia,gastroesophageal reflux and respiratory infection,etc.)and esophageal function were evaluated and analyzed by esophagogram,24h pH monitoring and esophageal manometry.Results Mean follow-up period was 53.08±45.2 months.More than 48%patients had a norrnal lire without any clinical symptom,and 85%of them developed normally.Late onset of anastomotic stricture was developed in 48.2%accompanying with different degree of dysphagia,and pathologic reflux existed in 22.2%patients.Esophageal dilation was performed in 22.2%patients,while the others with stricture relieved spontaneously.Esophageal dysmotility was found by esophageal manometry in 70.3%patients,in whom ahout 1/3 of patients had no symptom of dysphagia.Conclusions The late complications,such as anastomotic stricture,gastroesophageal reflux,esophageal dysmotility and respiratory infection,have little influence on the children's growth,development and everyaay life.Severe anastomotic stricture can be relieved by esophageal dilation.