Ⅰ型食管闭锁手术方式的选择及其疗效

Treatment strategy and prognosis analysis in children with type Ⅰ esophageal atresia

目的 分析Ⅰ型食管闭锁的术后近、远期并发症及长期生活质量,以探讨其最佳治疗策略.方法 回顾性分析2005年1月至2012年9月间广州市妇女儿童医疗中心收治的22例Ⅰ型食管闭锁患儿的临床资料.6例患儿家属放弃手术治疗,其余16例接受手术治疗,根据食管造影所判断的两盲端距离选择手术方式.2例于出生后即行一期近、远端食管端端吻合术；14例出生后行颈部食管造瘘和胃造瘘,其中8例完成二期胃管（胃）代食管吻合术,另有6例尚在等待二期手术.对上述行根治手术的10例患儿进行术后近、远期并发症、营养状况及神经发育情况评估.结果 10例根治手术患儿术后近期并发症：胸腔积液1例,吻合口瘘4例,倾倒综合征1例,吻合口狭窄1例；远期并发症：食管狭窄2例,反复呼吸道感染3例.术后随访2～62月,其中2例于随访2年后失访.按年龄别体质量,8例获随访的患儿中2例营养情况正常,5例存在轻度营养不良,1例存在中度营养不良;神经发育进程明显迟于正常儿童.结论 根据食管两侧盲端的距离来选择Ⅰ型食管闭锁的合理治疗方式,可以取得较为满意的治疗效果和长期生活质量.

Objective To analyze the postoperative short-term and long-term outcomes in the management of type Ⅰ esophageal atresia,and to explore the ideal operative strategy.Methods Clinical data of 22 patients with type Ⅰ esophageal atresia treated from January 2005 to September 2012 were retrospectively reviewed.Of 22 patients,6 patients gave up the treatment.Two underwent primary repair after birth.Of 14 patients undergoing cervical esophagostomy and gastrostomy,8 patients received esophageal replacement.Postoperative short-term and long-term complications,nutritional state and neurodevelopment were studied on above 10 children with radical operations.Results Of 10 patients with radical operation,the short-term complications were hydrothorax in 1 case,anastomotic leakage in 4,dumping syndrome in 1,anastomotic stricture in 1.The long-term complications were esophageal stricture in 2 cases,and repeated respiratory infection in 3.These complications could be managed successfully.The postoperative follow-up duration ranged from 2 to 62 months.Two cases were lost during follow-up after 2 years.Weight-for-age was normal in 2 patients,mild malnutrition in 5 patients,and moderate malnutrition in 1 patients.Neurodevelopment is significantly delayed as compared to normal children.Conclusions Operative strategy should be chosen according to the distance between proximal and distal esophagus in the treatment of type Ⅰ esophageal atresia.The efficacy of radical operation is relative satisfactory in terms of short-term and long-term complications and the quality of life.