先天性食管闭锁17例治疗体会

Congenital esophageal atresia:A report of 17 cases

目的:总结11年来先天性食管闭锁17例手术治疗的经验,介绍经胸膜外手术技术及其优点。方法:经胸膜外入路法即切开4/5肋间,小心分离肋间肌,先以小蚊式钳小心分开肋骨,再用食指剥离胸膜。注意操作轻柔,仔细剥离胸膜顶及肺门处。胸膜有少许破损可继续完成剥离。术后胸膜外间隙不需引流,食管内亦不留置支架。结果:17例中5例经胸食管吻合仅存活1例,11例胸膜外吻合存活8例(72.7%)。1例Ⅰ型结肠代食管成功。结论:通过17例先天性食管闭锁的治疗,体会到经胸膜外手术后呼吸系统并发症少,及早正确的诊治,熟练的手术技巧,减少食管吻合的张力是提高治愈率的关键。

Objective:To summarize the theraputic experiences of 17 cases of congenital esophageal atresia in the last 11 years and to introduce the technique of extrapleural approach. Methods:the extrapleural approach was done by the 4th intercostal incision and divided between intercostal muscles and pleura by mosquito clamp and index finger.The pleura at the top and the hilus of the lung should be dissected very gently and precisely.The drainage of the extrapleural space and the splinting tube in the esophageal anastomosis were not needed postoperatively.Re- sults:One patient survived among 5 cases operated by transpleural approach,and 8 survived in 11 cases by extrapleural approach.Conclusions:It is better to use the extrapleural approach to mini- mize the postoperative respiratory problems.The key points to improve the cure rate of esophageal atresia are early diagnosis and treatment,skillful operative technique,and tensionless anastomosis.