先天性食道闭锁术后短期-中期疗效评定

 目的回顾性分析我院诊治的先天性食道闭锁病例，总结诊断、治疗经验，分析影响预后因素，探讨术后短期鄄中期并发症
及其处理经验、教训。方法随访并回顾性分析近3年来我院诊断、治疗、随访的先天性食道闭锁患儿，应用食道闭锁预后分级
方法总结分析影响预后的主要因素。结果2006 年初~2009 年10 月临床资料完整的先天性食道闭锁病例48 例（男33 例，女
15 例），平均体质量2 667.86 g（1 700~3 800 g）；全部为玉期食道成形，主要术后并发症为肺炎、吻合口瘘（16%）、气管食管瘘、
切口感染（11%）、迟发型气管食管瘘（7%）、食道狭窄（10%），胃食管返流（67%）。死亡率为12.5%，主要死亡原因为严重肺内感
染及复杂先天性心脏病。结论绝大多数食道闭锁患儿可以耐受玉期食道吻合术，术后短鄄中期预后良好；术前及术后影响预
后及导致死亡的主要原因为复杂心血管畸形、误吸、肺内感染；主要中期并发症为胃食管返流、食道狭窄。

The Short to Long Term Surgical Outcomes of Congenital Esophageal Atresia

Objective To explore the short to long term surgical outcomes and treatment experiences of esophageal atresia（EA）. Methods
The clinical data of EA inpatients in our hospital from 2006 to 2009 were reviewed retrospectively. The birth weight，main associated anoma-
lies，details of management，complications and outcomes were discussed. Main risk factors were evaluated with major prognostic classification
systems. Results Totally 48 consecutive infants with EA were identified from 2006 to 2009，male 33（69%），female 15（31%）. Mean birth
weight was 2 668 g （range 1 700 g to 3 800 g）. All received primary operation. Complications included pneumonia，anastomotic leakage
（16%），tracheoesophageal fistula，incision sepsis（11%），delayed tracheoesophageal fistula（7%），stricture（10%），and gastroesophageal re-
flux （GER）（67%）. Mortality was 12.5%，mainly due to severe pneumonia and complex cardiac anomalies. Conclusion Most patients
with esophageal atresia could be cured after primary operation with excellent outcomes. The main factors for mortality were complex cardiac
anomalies，aspiration and pneumonia. The main mid-term complications were GER and stricture.