先天性食管闭锁的外科治疗体会

Surgical treatment of congenital esophageal atresia

目的 提高食管闭锁的治愈率。方法 总结 9例食管闭锁及气管食管瘘的一期吻合治疗经验 (3例合并硬肿症 )。采用胸膜外入路 6例 ,胸内手术 3例。 5例需作近端食管肌层切开延长。施行瘘管结扎、端侧吻合 5例 ,端端吻合 4例。结果 存活 7例 ,其中近年连续收治 6例全部治愈。出现吻合口瘘 2例。 1例因术后肺炎、硬肿症加重而死亡。结论 早期诊治 ,重视围手术期呼吸管理及营养支持 。

Objective To investigate how to increase the curative rate of esophageal atresia.Methods The therapeutic experience of primary anastomosis of 9cases of esophageal atresia and tracheoesophageal fistula(EA TEF) in the last 8 years was summarized.Among them, 3 cases were accompanied with scleroedema.The extrapleural approach was performed in 6 cases, and the transpleural approach adopted in 3 cases.Modified esophageal myotomy made a successful anastomosis reconstruction possible in 5 cases.Four cases received end to end esophagoesophagostomy and 5 direct ligation of TEF and end to side esophageal anastomosis.Results Of the 7 patients being alive, consecutive 6 patients were totally cured in recent years.Anastomotic leaks occurred in 2 cases, postoperative worsening pneumonia and scleroedema in one case.Conclusion To early diagnose and treat, strengthen respiration management and nutritional support during operation, select appropriate surgical procedures and make skillful operation were the key points to increase the curative rate.