胸腔镜食管吻合治疗小儿先天性气管软骨食管异位症

Thoracoscopic esophagectomy for congenital tracheobronchial cartilage remnants of esophagus in children

目的探讨小儿先天性气管软骨食管异位症的临床表现、诊断特点及胸腔镜食管端端吻合术治疗气管软骨食管异位症的方法、疗效。方法收集2008年3月至2010年5月收治的5例先天性气管软骨食管异位症患儿，术前进行影像学检查及胃镜检查，术中经胸腔镜行食管狭窄段切除，食管端端吻合术，男3例，女2例，年龄1．1～4岁，无中转开胸。结果本组患儿病史为反复呕吐，添加辅食时加重，平均生后6个月开始出现较典型的临床症状。钡餐检查分别为典型“钟摆征”、食管贲门间细线样改变，贲门失弛症不除外。术中探查食管壁有异物凸起，狭窄段均位于食管下段距贲门2．0～4．0cm范围，长0．5～1．0cm，直径0．2～0．4cm，近端食管扩张。胸腔镜下行食管狭窄段切除、食管端端吻合术，2例术后1个月出现吞咽困难，食道球囊扩张后缓解。结论本病手术是唯一可靠的治疗方法，胸腔镜食管狭窄段切除、端端吻合术术野清晰，出血少，打击小，减少了术后肺炎发生的机会，术后恢复快。

Objective The aim of this study was to explore the clinical manifestation and diagnostic characteristics of congenital tracheobronehial cartilage remnants of esophagus, and further evaluate the therapeutic efficacy of thoracoscopie esophagectomy on this disease. Methods Total 5 patients （M 3, F 2; ranging from 1.1 to 4 year old） were diagnosed as congenital tracheobronchial cartilage remnants of esophagus between March 2008 and May 2010. Preoperative imaging and endoscopy were carried out before surgery, and then followed by thoracoscopic resection of esophageal stricture and esophageal anastomosis without conversion to open surgery. Results All patients presented recurrent vomiting without gastric juice and bile, especially with complementary feeding. Patients started to appear typical clinical symptoms in 6 months after birth and generally affect healthy development. One patients showed a typical ＂pendulum sign＂ features in Barium meal examination, and two showed thin line change between the esophagus and cardia Three patients undertook esophagoscopic examinations in surgery, all of them showed a sudden expansion of esophageal stenosis and no passing through the stenosis segment. The stenosis segment was excised and interrupted full-thickness esophageal anastomosis with 5-0 PDS. Two patients appeared dysphagia in postoperative one month, esophageal imaging showed a lower esophageal stricture, and symptoms were reduced after esophageal balloon dilatation. Conclusions Surgery is the only reliable way to treat this disease, and the patient nutrition condition should be adjusted before surgery. Thoracoscopic resection of esophageal stricture has some advantages involving less bleeding, quick recovery and minimally invasive injury to chest wall, as well less chances of postoperative pneumonia.