胸腔镜手术与开胸手术治疗Ⅲ型食管闭锁的对比研究

Comparative study of thoracoscopy and thoracotomy for the treatment of type Ⅲ esophageal atresia

目的比较胸腔镜手术与开胸手术治疗先天性食管闭锁并食管气管瘘的临床疗效。方法 2011年6月至2015年7月间本院共收治112例先天性食管闭锁并食管气管瘘患儿,其中54例行胸腔镜手术(胸腔镜组),58例行开胸手术(开胸组),对两组患者的一般资料、围手术期情况和术后效果进行比较。结果胸腔镜组54例中51例完成一期食管气管瘘修补+食管吻合术,3例中转开胸手术,术后4例放弃治疗。开胸组58例中57例一期完成食管吻合术,1例术中见两盲端相距4 cm,需先行胃造瘘术,家长放弃治疗,术后3例放弃治疗。手术时间胸腔镜组为(138±30)min,开胸组为(122±23)min,经统计学分析差异有意义(t=3.206,P<0.001);术后呼吸机使用时间胸腔镜组为(1.68±0.42)d,开胸组为(1.12±0.23)d,两组比较差异有统计学意义(t=9.000;P<0.001);住院天数胸腔镜组平均为(20.63±3.54)d,开胸组平均为(19.75±2.87)d,两组对比差异无统计学意义(t=1.467,P=0.074)。胸腔镜组54例中9例吻合口漏(16.7%),5例吻合口狭窄(9.3%),1例食管气管瘘复发(1.9%)。开胸组58例中6例吻合口漏(10.3%),10例(17.2%)吻合口狭窄,2例(3.4%)食管气管瘘复发,两组比较差异无统计学意义(χ~2=0.143,P=0.705)。结论胸腔镜手术治疗先天性食管闭锁并食管气管瘘是安全可行的,结果与开胸手术相当,但远期效果仍需进一步随访。

Objective To evaluate the clinical results of thoracoscopy versus thoracotomy for esophageal atresia(EA)and tracheoesophageal fistula(TEF).Methods There were 112 cases with EA and TEF from June 2011 to July 2015.54 patients who were underwent thoracoscopy while other 58 underwent thoracotomy.General data with perioperative and post-operative outcomes were retrospectively analyzed between the two groups.Results Thoracoscopy was completed in 51 cases and there were 3 patients turn to open thoracotomy surgery,4 patients given up postoperative.And 57 cases underwent through-pleural esophageal anastomosis and 1 patient was adjourned in operation because of excessively long gap and needed to do gastrostomy first,another 3 patients relatives given up postoperative.The mean operative time was 138±30 min for thoracoscopyversus 122±23 min for open thoracotomy surgery,There were statistical significance(t=3.206,P<0.001).The mean time to extubation was 1.68±0.42 versus 1.12±0.23 days.There were statistical significance(t=9.000,P<0.001);The mean length of in-hospital stay was 20.63±3.54 versus 19.75±2.87 days,with no statistical significance(t=1.467,P=0.074).The anastomotic leak rate was 16.7%versus 10.3%.The stricture rate was 9.3%versus 17.2%.The recurrent rate of TEF was 1.9%versus 3.4%.There were no statistical significance(χ2=0.143,P=0.705).Conclusion The thoracoscopy technique is safe and feasible for type-ⅢEA/TEF,but need to further follow up for the long-term effect.