先天性食管闭锁合并十二指肠梗阻的诊治

Diagnosis and treatment of congenital esophageal atresia plus duodenal obstruction:a report of 5 cases

目的探讨先天性食管闭锁合并十二指肠梗阻的诊疗策略。方法回顾性分析2018年1月1日年至2019年6月1日首都医科大学附属北京儿童医院收治的5例先天性食管闭锁合并十二指肠梗阻患儿的临床资料。其中,男3例,女2例;出生体重为1750~3500 g,平均2930 g;均为Ⅲ型食管闭锁;2例为十二指肠膜式闭锁,3例为十二指肠膜式狭窄。有2例首诊于外院,入院时已行开胸食管吻合手术;另3例生后即首诊于我院。结果5例患儿中,2例十二指肠闭锁在首次手术前明确诊断,3例十二指肠膜式狭窄在首次手术前未能诊断。5例患儿均为先行食管吻合手术,二期再行腹腔镜下十二指肠隔膜切除+纵切横缝术,术后恢复顺利,两次手术间隔时间为1周至20个月,平均22周。5例并发食管狭窄,1例气管食管瘘复发,未见胃食管反流,吻合口漏。食管狭窄行胃镜下球囊扩张治疗,复发气管食管瘘行胸腔镜手术修补治愈。术后随访3个月至1年,5例患儿可正常经口喂养,生长发育好,体重增长满意。结论对于食管闭锁(Ⅲ型)合并十二指肠梗阻患儿,术前胸腹联合立位X线片和腹部超声检查有助于诊断。先行胸腔镜食管吻合手术,1周后再行腹腔镜下十二指肠吻合,分期实施手术的疗效安全、满意。

Objective To explore the diagnostic and therapeutic strategies of congenital esophageal atresia plus duodenal obstruction.Methods The clinical data were retrospectively collected for 5 cases with congenital esophageal atresia typeⅢplus duodenal obstruction from January 1st,2018 to June 1st,2019.There were 3 boys and 2 girls with an average body weight of 2930(1750-3500)gram.There were duodenal membrane atresia(n=2)and duodenal membrane stenosis(n=3).Two cases of esophageal anastomosis were initially diagnosed at other hospitals and thoracotomy was performed at the time of admission.Another 3 cases came to our hospital for initial consultations.Results Two cases of duodenal atresia were definitely diagnosed preoperatively and 3 cases of duodenal membrane stenosis were not diagnosed preoperatively.All of them underwent esophageal anastomosis followed by laparoscopic duodenal diaphragm resection plus longitudinal incision and transverse suturing.The postoperative recovery was smooth and the average interval between two operations was 22(1-20)months.The postoperative complications included esophageal stenosis(n=5)and recurrence of tracheoesophageal fistula(n=1).There was no occurrence of gastroesophageal reflux or anastomotic leakage.Esophageal stricture was managed with gastroscopy balloon dilation and recurrent tracheoesophageal fistula by thoracoscopy.During a follow-up period of 3-12 months,all children were fed orally normally with decent growth and satisfactory weight gain.Conclusions For esophageal atresia(typeⅢ)plus duodenal obstruction,preoperative thoracoabdominal radiograph and abdominal ultrasound are helpful for diagnosing.Staged repair consists of thoracoscopic esophageal anastomosis and duodenal anastomosis under laparoscopy after 1 week.