食管闭锁术后食管再手术的临床探讨

Re-operation after the primary repair for patients with esophageal atresia

目的分析总结食管闭锁术后食管再手术的临床经验。方法2005年6月至2011年7月，8例接受食管闭锁术后食管再手术患儿，男6例，女2例。再手术时年龄6～52个月。7例GrossⅢ型，1例GrossⅠ型。再手术前表现为进食后呛咳及进食困难。6例食管气管瘘复发，2例严重狭窄反复扩张无效。8例行食管造影和食管镜检查瘘管及狭窄情况；4例行支气管镜检查。6例术中单肺通气。8例经右胸再手术，切断、缝扎食管气管瘘管，切除狭窄段食管并端端吻合。结果平均手术时间3～3．5h。平均住院时间25d。随访1～72个月，无患儿发生吻合口瘘和食管气管瘘再复发。1例患儿吻合口狭窄扩张1次。结论食管气管瘘复发多与瘘管未切断及局部炎症有关；食管狭窄与吻合张力高及吻合口漏相关。食管气管瘘复发或／和严重吻合口狭窄是食管再手术的指征。食管镜、支气管镜联合运用，有助于食管气管瘘管复发的诊断和术中定位。单肺通气为再手术提供相对安全的麻醉方式。食管再手术后恢复良好。

Objective The aim of the study is to summarize the clinical experience of re-opera- tion after esophageal atresia （EA） primary repair. Methods From 2005.6 - 2011.7, 8 cases of reop- eration were performed in our hospital after primary esophageal atresia repair. There were 6 males to 2 females. Patientg ages ranged from 6m to 52 rn. 7 cases were Gross type Ⅲ and Ⅰwas Gross type Ⅰ. Thepresenting complaints were coughing after feeding or feeding difficulty. 6 cases had TEF recur- rence and 2 cases had severe anastomotic stricturerefractory to dilatation. All cases had pre-operative esophagogram and esophagoscopic examinations. 4 also had bronchoscopy. Single lung ventilation was required in 6 patients during procedure. All cases had access via right-sided thoracotomy. Results The average re-operation time was 3.5 h, and the average stay in hospital was 25 d. All patients stayed in PICU for several days. Follow-up period ranged from 1-72 m. No anastomotic leakage or re- currence of fistula occurred, l patient needed anastomotic dilatation once. Conclusions Factors such as not cutting the fistula in primary repair, high tension, leakage and inflammation couldall cause TE- FR and AS. TEFR and/or serious AS are the indications for re-operation after EA primary repair. Esophagoscopy and bronchoscopy before re-operation are very important for TEFR diagnosis and treatment. Unilateral lung ventilation during anaesthesia procedure can provide more security for patients. In general, prognosis was good after reperation.