手术治疗新生儿Ⅲ型食管闭锁12例疗效观察

SURGICAL TREATMENT OF 12 INFANTS WITH TYPE Ⅲ CONGENITAL ESOPHAGEAL ATRESIA

目的探讨新生儿Ⅲ型食管闭锁的治疗方法,观察其临床效果。方法对我院2000-2007年收治的12例先天性食管闭锁型患儿的临床资料进行回顾分析。手术全部经胸腔入路,结扎食管气管瘘,两盲端距离小于2 cm者,采用单层吻合两盲端,大于2 cm者,采用Livaditis行Ⅰ期食管吻合术。结果9例患儿获得痊愈,死亡3例,其中吻合口瘘死亡1例,术后肺炎加重死亡2例。9例患儿获得随访1-6年,吻合口狭窄1例,经扩张后治愈,其余吻合口均通畅。结论早期诊断、术中精细轻柔的操作及术后高质量的监护是手术成功的关键。

Objective To review the experience of surgical treatment of 12 infants with type Ⅲ congenital esophageal atresia.Methods From 2000 to 2007,the clinical data of 12 cases of congenital esophageal atresia were analysed retrospectively in our hospital.The transpleural approach was adopted in all cases.The esophago-tracheal fistula was ligated.The cases which distance from the distal cecum to the proximal esophageal pouches was less than 2cm received end-to-end esophagoesophagostomy,while stage I Livaditis operation was performed for those whose cecumlength was over 2cm.Results Nine cases were cured and 3 died after operation.The causes of death were anastomotic leak in 1 case and postoperative worsening pneumonia in 2.Conclusion Early diagnosis,perioperative skillful manipulation and postoperative high-quailty intensive care are the key to successful operation.