摘要
目的探讨先天性V型食管闭锁的临床特点、诊治及预后情况。方法回顾性分析2007年3月至2020年12月在首都医科大学附属北京儿童医院确诊并接受治疗的40例先天性V型食管闭锁患儿临床资料;其中男16例,女24例。收集并总结分析所有患儿临床表现及辅助检查结果、诊治经过及预后情况。结果40例患儿中,27例(27/40,67.5%)于1岁内确诊。临床表现包括进食时呛咳、窒息、青紫(35/40,87.5%)以及反复肺部感染(25/40,62.5%)。40例均经食管造影(阳性率97.4%)和(或)纤维支气管镜(阳性率100.0%)检查确诊。34例瘘管位于第7颈椎至第2胸椎水平,经颈部入路行气管食管瘘修补术;6例瘘管位于第2至第4胸椎水平,采用右侧胸膜外入路。32例治愈;1例术后造影发现第二条瘘管;5例出现喉返神经损伤;1例出现吻合口漏,经保守治疗1个月后痊愈;1例死于呼吸衰竭。36例获随访,3例失访;3例气管食管瘘复发,经再次手术后治愈;1例出现食管狭窄,经扩张5次后治愈。其余患儿生长发育正常,无不适表现。结论先天性V型食管闭锁临床症状不典型,易误诊,对可疑患儿行食管造影和纤维支气管镜检查有助于明确诊断。手术治疗效果良好,需警惕术后喉返神经损伤的可能。
Objective To explore the clinical characteristics,diagnosis and therapeutic principles of congenitalesophageal atresia type V.Methods Retrospective analysis was conducted for clinical data of children with congenital esophageal atresia type V from March 2007 to December 2020.There were 16 boys and 24 girls.The relevant clinical manifestations,auxiliary examination results,therapeutic principles and outcomes were recorded.Results Among them,27(80.0%)were diagnosed within 1 year of age.Clinical manifestations included ingesting choking(87.5%)and recurrent pneumonitis(62.5%).A definite diagnosis was made by esophagography and/or fiberoptic bronchoscopy with a positive rate of 97.4%and 100.0%respectively.And 34 cases of fistula at C7-T2 were repaired through a cervical approach.Thoracic approach was selected for 6 cases of fistula at T2-T4.Thirty-two cases were cured.Postoperative esophagography revealed a second fistula(n=1).Recurrent laryngeal nerve injury was present in 5 cases.One child of fistula repairing through a thoracic approach had anastomotic leak and was cured after 1-month conservative treatment.One child died from respiratory failure.Thirty-six cases were followed up and 3 cases became lost.Tracheoesophageal fistula recurred in 3 cases and was cured after reoperation.One case of esophageal stenosis was cured after 5 dilations.The remainders recovered well.Conclusion Clinical symptoms of congenital esophageal atresia type V are non-typical so that it may be easily misdiagnosed.Esophagography and fiberoptic bronchoscopy aid in a definite diagnosis.Surgery has an excellent efficacy.Postoperative recurrent laryngeal nerve injury should be avoided.
作者
王沛则
赵勇
杨深
华凯云
张雅楠
黄金狮
Wang Peize;Zhao Yong;Yang Shen;Hua Kaiyun;Zhang Yanan;Huang Jinshi(Department of Neonatal Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)
出处
《临床小儿外科杂志》
CAS
CSCD
2023年第4期318-322,共5页
Journal of Clinical Pediatric Surgery
基金
首都临床特色诊疗技术研究与转化应用(Z211100002921062)
关键词
食管闭锁
诊断
外科手术
治疗结果
Esophageal Atresia
Diagnosis
Surgical Procedures,Operative
Treatment Outcome
