摘要
目的 探讨应用食管自然生长结合食管内张力延长治疗Ⅰ型食管闭锁诊疗策略.方法 2012年1月至2017年1月,江西省儿童医院新生儿外科收治10例Ⅰ型食管闭锁新生儿患儿,男5例,女5例.患儿出生后置入胃管困难,完善食管造影考虑诊断Ⅰ型食管闭锁,于新生儿期行腹腔镜下胃造瘘术,术中完善食管盲端造影,确定食管缺失长度.予以经胃造瘘肠内营养,近端食管盲端吸引唾液,定期检查评估食管生长情况,结合食管自然生长及食管内张力延长两种方法使食管延长,延期行胸腔镜下食管端端吻合术.结果 2例经食管自然生长完成胸腔镜下食管端端吻合,完成吻合时年龄分别为153 d、151 d.8例生后12周以上的患儿食管盲端仍相距大于4个椎体,予以食管内张力延长促进食管生长后完成胸腔镜下食管端端吻合.患儿开始行食管内延长年龄为(174.3±86.6)d(92~280 d),开始行食管内延长时食管盲端相差椎体数为(5.1±0.5)个椎体(4.5~6.0个椎体),行内延长时间为(49.0±16.2)d(28~69 d).术后7 d食管造影2例患儿存在食管吻合口漏,均经保守治疗后自愈,术后有10例患儿出现不同程度的食管狭窄需要食管扩张,随访2~7年,所有患儿生长发育良好.结论 通过食管自然生长结合食管内张力延长的方法治疗Ⅰ型食管闭锁,可达到使用自身食管完成食管端端吻合的目的.术后效果满意,是一种值得选择的诊疗策略.
Objective To explore the management strategies of type Ⅰ esophageal atresia (EA) through natural growth and tension-extension .Methods From January 2012 to January 2017 ,a total of 10 children of type-Ⅰ EA were recruited .There were 5 boys and 5 girls .Difficult postnatal insertion of gastric tube prompted a clinical diagnosis of type-Ⅰ EA after esophagography .Within a month after birth ,laparoscopic gastrostomy was performed .During operation ,the distance between proximal and distal esophagus was measured on esophageal radiography .And nutrient liquid was supplied via gastrostomy .Saliva was reabsorbed through proximal esophagus and esophageal grow th measured regularly .Esophageal extension was achieved through natural growth and tension-extension .Thus thoracoscopic gastroesophagostomy was delayed .Results Two cases of thoracoscopic esophageal anastomosis were achieved through natural growth .The completion ages were 153 and 151 days respectively .In another eight cases , the distance between proximal and distal esophagus was still greater than the total length of four vertebrates at 12 weeks post-birth .Tension-extension was applied for promoting the growth of esophagus and thoracoscopic gastroesophagostomy performed .And esophagectasia was performed postoperatively for counteracting esophageal stenosis .When starting endo-esophogeal lengthening ,the mean age was (174 .3 ± 86 .6) (92-280) days and the mean vertebral number between esophogeal ends (5 .1 ± 0 .5)(4 .5-6 .0) .And the extended time was (49 .0 ± 16 .2) (28-69) days .At Day 7 postoperatively , esophogeal contrasting radiography revealed esophogeal anastomotic fistula (n=2) .Both cases were cured after conservative measures .Esophogeal stenosis of varying degrees (n=10) required esophogeal dilatation .During follow-ups ,all children had excellent growth and development .Conclusions Promoting esophageal extension through natural growth and tension-extension reduces pre-anastomotic surgical trauma and postoperative adhesion .Thoracoscope allows a distinct exsanguine operative field for minimizing surgical trauma .The recovery is satisfactoryafter treatment .This promising treatment is worth a wider popularization .
作者
樊纬
黄金狮
陈快
陶俊峰
刘智文
徐美汉
曾祥勇
甘亮
杨治
陶强
Fan Wei;Huang Jinshi;Chen Kuai;Tao Junfeng;Liu Zhiwen;Xu Meihan;Zeng Xiangyong;Gan liang;Yang Zhi;Tao Qiang(Department of Neonatal Surgery,Jiangxi Children’s Hospital,Nanchang 330006,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2019年第11期993-997,共5页
Chinese Journal of Pediatric Surgery
基金
江西省卫计委课题项目(20171130)。
关键词
食管闭锁
胸腔镜
食管延长
Esophageal atresia
Thoracoscopes
Esophageal extension
