先天性食管闭锁两种手术途径的对比研究

目的 比较经胸腔和经胸膜外两种手术途径治疗先天性食管闭锁的疗效差异.方法 回顾性分析2002年1月至2007年4月在本院手术治疗的34例先天性食管闭锁（Ⅲ型）患儿临床资料,男27例,女7例,均行食管气管瘘结扎、食管端端吻合术.其中经胸腔手术（为经胸腔手术组）19例,经胸膜外手术（为经腹膜外手术组）15例.两组术前均有肺炎,心脏彩超检查提示21例有房面分流（考虑为房间膈缺损或卵圆孔未闭）和（或）动脉导管未闭,但均无肺动脉高压,心功能正常.结果 经胸腔手术组平均手术时间（2.17±0131）h,呼吸机使用时间为（21.07±25.42）h;术后需呼吸机辅助通气15例,发生气胸11例、胸腔积液10例、吻合口瘘5例;治愈16例,治愈率84.2%.经胸膜外手术组平均手术时间为（2.13±0.45）h,呼吸机使用时间为（9.27±13.70）h;术后需呼吸机辅助通气6例,发生气胸3例、胸腔积液2例、吻合口瘘6例;治愈13例,治愈率86.7%.结论 经胸腔和经胸膜外两种手术途径治疗先天性食管闭锁治愈率相当,所需手术时间和呼吸机使用时间无显著差异;但术后经胸膜外手术组需呼吸机辅助通气的几率明显降低,且发生气胸、胸腔积液的几率亦明显低于经胸腔手术组.

Comparison of two operative approaches for congenital esophageal atresia

Objective To compare the transpleural and extrapleural operative approaches for congenital esophageal atresia （CEA）. Methods The data of 34 patients with CEA were analysed retrospectively. There are 27 males and 7 females. All the patients undergone the ligation of tracheoesophageal fistula and end-to-end anastomosis of esophagus. 19 patients received transpleura] operation while 15 received extrapleural operation. Everyone had pneumonia and 21 cases had congenital heart disease. Results In the group of transpleura] operation, the average operative time was（2.17 ±0.31）h and lasting time 6f intubation was（21.07 ±25.42）h. After operation, there were 15 patients treated by ventilation. 11 had pneumothorax. 10 had pleural effusion and 5 had anastomotie fistula. In the group of extrapleural operation, the average operative time was（2.13 ±0.45）h and lasting time of intubation was （9.27 ±13.70）h. 6 patients need the treatment of ventilation after opertation. 3 had pneumothorax. 2 had pleural effusion and 6 had anastomotic fistula. The cure rates were 84.2% and 86.7% respectively. Conclusions There was no significant difference between the transpleural and extrapleural operation groups in operative time, lasting time of intubation and cure rate. But the probability of ventilation treatment, pneumothorax and pleura] effusion were distinctly lower in the extrapleural operation group.