结肠代食管治疗食管闭锁术后严重并发症的治疗体会及文献复习

Experiences of colonic replacement for severe postoperative complications of esophageal atresia and literature review

目的食管闭锁术后严重并发症如吻合口漏经久不愈和食管气管瘘反复发作等，临床治疗非常困难，本文总结应用结肠代食管获得良好临床效果的治疗经验。方法自2007年1月至2015年12月，我院施行结肠代食管术6例，其中Ⅰ型2例，Ⅲa型4例。均为Ⅰ型食管闭锁行食管近端造瘘、胃造瘘术或一期食管吻合术后出现吻合口漏经久不愈或复发性食管气管瘘多次修补失败，经常规手术治疗未果而施行结肠代食管。结果6例患儿结肠代食管术均获得成功并治愈出院。随访9个月～10年，术后4例出现近端吻合口漏，3例吻合口狭窄，3例术后肺部感染，1例应激性溃疡大出血，对症治疗后均治愈。6例患儿均未出现反酸、呕吐等胃食管反流症状。所有患儿目前均完全经口喂养，无特殊饮食条件控制，无口腔异味，生长发育与同龄儿相比无明显落后。结论对于食管闭锁近端食管造瘘术后、食管吻合术后吻合口漏反复治疗未愈、难治性复发性食管气管瘘等复杂并发症，结肠代食管可作为优选根治性治疗方案。

ObjectiveTo explore the feasibility of managing such severe complications after anastomosis of esophageal atresia （EA） as anastomotic leakage and recurrent esophageal tracheal fistula.MethodsFrom January 2007 to December 2015, 6 EA patients underwent colonic replacement. The clinical types were Ⅰ （n=2） and Ⅲa （n=4）. Esophageal replacement was performed for refractory anastomotic leakage and recurrent trachea esophageal fistula after initial esophageal myomectomy and gastrostomy.ResultsColonic replacement was performed successfully and all 6 patients were cured and discharged. There were proximal anastomotic leakage （n=4）, anastomotic stricture （n=3）, pulmonary infection （n=3） and bleeding of stress gastric ulcer （n=1）. All complications were cured conservatively. The follow-up period lasted from 9 months to 10 years. All of them received oral feeding without dietary control and there was no occurrence of acid reflux, vomiting or oral odor. Physical growth and development stayed within the same range as counterparts of the same age.ConclusionsColonic replacement for esophagus is ideal for managing severe postoperative complications during esophageal myomectomy and gastrostomy of long gap EA, refractory anastomotic leakage and recurrent trachea esophageal fistula after esophageal anastomosis.