先天性食管闭锁12年疗效评价

目的分析本中心12年来先天性食管闭锁的手术方式及术后近远期并发症，探讨提高食管闭锁治愈率的临床方法。方法对1999年1月至2010年12月作者收治的139例食管闭锁患儿诊治过程、疗效及并发症的防治进行回顾性分析。结果总治愈率84．17％（111／139），其中I型治愈率为100％（5／5），111a型治愈率为60．71％（17／28），IIIb型治愈率为83．81％（88／105），V型治愈率为100％（1／1）。术后近期吻合口瘘的发生率为19．42％（27／139）。103例随访病例中，远期吻合口狭窄的发生率为24．27％（25／103），25例接受食管狭窄球囊扩张术，年龄〈6个月者12例，平均扩张2．1次，年龄〉6个月者13例，平均扩张3．6次，21例扩张后症状明显缓解，4例放置食管人工支架辅助持续扩张2～4周后症状缓解。结论提高食管闭锁患儿治愈率需要早期诊断、加强术前术后的管理、改进手术方式以及积极有效地预防和治疗术后并发症。

Outcome of congenital esophageal atresia over the last 12 years

Objective To investigate operative procedure and management of the complications of postoperation and to raise the rate of survival in infants with congenital esophageal atresia over the last 12 years. Methods Retrospectively Sum up the experience of the treatment of 139 neonates with congenital esophageal atresia in 1999 -2010, and analyze the prevention and management of the postoperative complications. Re- sults The whole recovery rate is 84.17%. The recovery rate of type I , type ma, type lllb and type V are respectively 100% , 60. 71%, 83.81%, 100%. Anastomotic leaks after operation occurred in 19.42%. Anastomotic strictures after operation occurred in 24.27% in the 103 follow-up cases. 25 patients approved anastomotic strictures accepted balloon dilations. Cure rate and anastomotie leaks are not significantly differ- ence, but anastomotic strictures significantly increase. In 37 fonow-up cases, 15 patients approved anastomotie strictures balloon dilation. 12 patients are 〈 6 months, average dilation is 2.1 times. 13 patients are 〉 6 months, average dilation is 3.6 times. The symptoms significantly improve in 21 patients after dilation, but 4 patients need to be planted the esophageal stent for 2 to 4 weeks. Conclusions Early diagnosis, progressive operative procedures improved intensive care management, and prevention of postoperative complications at the right moment are the key of successively operation on infants with EA