胸腔镜下一期手术治疗食管闭锁合并气管软化的短期疗效

Short-term outcomes of one-stage thoracoscopy for esophageal atresia plus tracheomalacia

目的评估胸腔镜下一期气管后壁悬吊术联合食管端端吻合术治疗食管闭锁合并气管软化的有效性及安全性。方法本研究为回顾性研究。以2018年1月至2020年1月湖南省儿童医院新生儿外科收治的11例食管闭锁合并中度(气管软化评分在81%~90%)或重度(气管软化评分在91%~100%)气管软化的患儿为研究对象,患儿均在胸腔镜下行气管后壁悬吊术联合食管端端吻合术治疗。收集所有患儿术后呼吸机通气时间、围手术期并发症以及短期随诊结局,进而评估气管后壁悬吊术联合食管端端吻合术治疗食管闭锁合并气管软化的有效性和安全性。结果11例均在胸腔镜下完成气管后壁悬吊术联合食管端端吻合术,无一例中转开胸病例。术中气管悬吊固定时间为7(5~8)min,无一例气管损伤发生。术后气管插管呼吸机辅助通气时间为65(15~189)h。2例出现食管瘘,均经保守治疗愈合,其中1例出现食管狭窄,行球囊扩张后缓解。随访12(10~15)个月,1例反复出现呼吸困难、呼吸道感染,经多次住院治疗,1年后逐渐好转。结论胸腔镜下气管后壁悬吊能在解剖上改善气管软化,缩短术后呼吸机辅助通气时间,预防气管软化症的发生,手术时间短,安全可靠,可作为一项新技术推广。

Objective To evaluate the safety and efficacy of thoracoscopic posterior tracheopexy and esophagus anastomosis for esophageal atresia plus tracheomalacia.Methods From January 2018 to January 2020,11 cases of esophageal atresia plus moderate(tracheomalcia score:81%-90%)or severe(tracheomalacia score:91%-100%)tracheomalacia were included.All infants underwent thoracoscopic posterior tracheopexy and end-to-end esophageal anastomosis.Postoperative ventilation time,perioperative complications and short-term follow-up outcomes were recorded.Results Posterior tracheopexy and end-to-end esophageal anastomosis were performed under thoracoscopy without any conversion into thoracotomy.Operative duration of posterior tracheopexy was 7(5-8)min and postoperative tracheal intubation time 65(15-189)h without any tracheal injury.Two cases of esophageal fistula were cured with conservative measures.And one child of esophageal stenosis improved after dilatation.During a follow-up period of 12(10-15)months,1 case of recurrent dyspnea and respiratory infection gradually improved after many hospitalizations.Conclusion Thoracoscopic posterior tracheopexy can improve tracheomalacia anatomically,shorten postoperative ventilation time and prevent the occurrence of tracheomalacia.With a short operative duration,the procedures are both safe and reliable.This new technique is worth a wider popularization.