食管闭锁术后并发症发生的影响因素研究

Influencing factors for postoperative complications of esophageal atresia

目的探讨Ⅲ型食管闭锁患儿基础条件及术中处理因素与术后并发症发生率之间的关系。方法对2012年1月至2016年8月实施根治手术的Ⅲ型食管闭锁76例患儿进行回顾性分析。男49例，女27例，年龄10h～22d，平均（3．79±3．81）d，体重1．38～4．3kg，平均（2．73±0．58）kg。所有患儿均伴有不同程度肺炎，38例（50％）合并心血管等其他系统畸形。73例行经胸开放手术，3例胸腔镜下手术。根据术后有无并发症、食管盲端间距长度（〉2cm及≤2cm）、患儿出生体重（〉2500g及〈2500g）以及是否合并其他畸形等分别进行统计学分析。结果全组76例患儿无住院死亡，随访1～55个月。术后3～4d吻合口漏2例，均立即再次行手术治愈；吻合tel狭窄19例，其中16例手术1个月后在胃镜下行球囊扩张1～6次后好转，3例术后狭窄严重，手术治疗后正常。气管狭窄2例，其中1例行气管支架治疗。随访期间死亡2例，均为反复性感染家长放弃治疗。术前食管盲端间距〉2cm组和≤2cm组、出生体重〉2500g组和〈2500g组、合并心血管畸形组和不合并心血管畸形组出现并发症的患儿分别为41．67％（15／36）和15．oO％（6／40）、16．98％（9／53）和52．17％（12／23）、51．85％（14／27）和16．33％（8／49），差异有统计学意义。无并发症组和有并发症组手术时间分别为（135．3±27．2）min、（136．8±34．3）min，差异无统计学意义。结论食管闭锁患儿术后并发症的发生率与出生体重、食管盲端间距、是否有合并症有一定相关性，术后并发症的发生率与手术时间等因素无明显相关。

Objective To evaluate the postoperative complications of esophageal anastomosis for esophageal atresia （EA） in children. Methods From January 2012 to August 2016, a total of 76 EA cases undergoing esophageal end-to-end anastomosis were recruited. There were 36 type Ⅲ-a and 40 type Ⅲ-b according to the Gross＇ classification scheme. There were 49 boys （64. 47%） and 27 girls （35.53%） with a mean birth weight range of （2 730± 580） （1 380-4 300） grams and a mean age （3. 79±3. 81） （0. 4-22） days. They were divided into two subgroups based upon complications, length of blind esophageal end and birth weight. Results All patients underwent operative esophageal correction and survived. The follow-up period was from 1 month to 4 years. Two cases were re- operated for anastomotic leakage. Among 19 cases of anastomotic stricture, 16 cases underwent endoscopic balloon dilatation at 1 month while another 3 cases with severe postoperative stenosis had excision and anastomosis of esophageal stricture at 3, 5 and 8 months. Significant differences existed between non-complicated and complicated groups in length of blind esophageal end, birth weight and cardiovascular malformation. However, no significant difference existed in operative age （3.12 ± 2. 24 vs 1.86± 1.46 days） or average operative duration （135.3 ±27. 2 vs 136. 8 ± 34. 3 min）. Conclusions Birth weight and length of blind esophageal end are more likely to be risk factors for complicated patients. However, complication is no significant correlation with operative duration.