先天性食管闭锁术后再手术的临床分析

Clinical analysis of reoperation after primary repair with esophageal atresia

目的总结先天性食管闭锁(CEA)术后再手术的原因及临床体会。方法回顾性分析2006年9月至2015年11月徐州市儿童医院收治的5例CEA术后再次手术患儿的临床资料。结果再手术患儿月龄5~14个月,所有患儿均为GrossⅢ型,1例食管气管瘘(TEF)复发,4例食管吻合口狭窄经食管扩张治疗无效。患儿术前均行食管造影及食管镜检查,TEF患儿行支气管镜检查明确瘘管。所有患儿均再次经胸完成手术,平均手术时间4.1 h,平均住院时间27 d。随访6个月~3年,无吻合口瘘及TEF复发,2例发生食管吻合口狭窄行食管扩张治疗痊愈。结论 TEF复发、严重食管吻合口狭窄是CEA术后再手术的主要原因,食管镜及支气管镜检查有助于术前诊断,再手术患儿预后良好。

Objective To summarize the cause of reoperation and reoperative experience for congenital esophageal atresia. Methods From September 2006 to Novemberr 2015 , the clinical data of five patients of reoperation after the primary repair withcongenital esophageal atresia in our hospital were analyzed. Results Their ages ranged from 5 to 14 months. All cases were Gross type IH , among whom one case had recurrent tracheoesophageal fistula and four cases had severe anastomotic stricture. All cases had preoprative esophagogram and esopha- goscopy examinations, and the case of TEF recurrence also had bronchoscopy. All patients underwent reoperation. The average reoperative time was 4. 1 hours, and the average stay in hospital was 27 days. All cases were followed up for 6 months to 3 years. No anastomotic leakage or recurrent fistula occurred. Two cases had anastomotic stricture and they were cured by dilation. Conclusion RTEF and severe anastomotic stricture are the primary causes of reoperation after the primary repair withcongenital esophageal atresia. Esophagogram and esophagoscopy ex-aminations are very important for preoprative diagnosis. The prognosis of reoperation is satisfactory.