Ⅲ型先天性食管闭锁术后患儿近中期预后分析

The short-term and medium-term outcomes of children with type-Ⅲcongenital esophageal atresia after surgery

目的总结先天性食管闭锁术后患儿的近中期生存质量,为先天性食管闭锁患儿的临床多学科管理提供参考。方法回顾性分析我院2007年11月至2018年11月手术治疗的Ⅲ型先天性食管闭锁患儿临床资料,分析近中期生存质量。结果62例患儿中,16例自动出院,1例死亡,45例纳入近期随访。Gross分型Ⅲa 35例,Ⅲb 10例,长段型5例,44例一期手术治愈,1例延期手术治愈,二次手术9例。术后近期并发症:吻合口瘘8例(17.8%),吻合口狭窄11例(24.4%),气管食管瘘复发2例(4.4%),血流感染14例(31.1%),手术切口感染4例(8.9%)。38例纳入术后中期随访:2例因误吸死亡,食管狭窄行食管扩张29例(76.3%),1.5岁有吞咽功能障碍5例(13.2%),胃食管反流3例(7.9%),营养不良6例(15.8%)。多学科协作后的生存率升高(57.1%对85.3%,P=0.013),吻合口瘘的发生率下降(46.4%对20.6%,P=0.03)。结论进行多学科合作,规范先天性食管闭锁患儿的术后随访,可提高其生存质量。

Objective To analyze the short-term and medium-term survival status of children with congenital esophageal atresia,and to provide reference for clinical multidisciplinary management of children with congenital esophageal atresia.Methods The clinical data of neonates with typeⅢcongenital esophageal atresia who were operated in our hospital between November 2007 to November 2018 and followed up in this hospital were analyzed retrospectively.Results Among the 62 cases,16 cases were discharged automatically,1 case died,and 45 cases were included in the short-term follow-up.35 cases were classified as grossⅢa,10 asⅢb,5 as long segment type,44 patients accepted one-stage surgery,1 infant accepted delayed operation,9 infants received second operations.Anastomotic leakage occurred in 8 cases(17.8%),anastomotic stenosis in 11 cases(24.4%),recurrence of tracheoesophageal fistula in 2 cases(4.4%),blood flow infection in 14 cases(31.1%),incision infection in 4 cases(8.9%).The medium-term survival status of 38 cases:2 cases died of aspiration,29 cases(76.3%)of anastomotic stenosis underwent esophageal dilatation,5 cases(13.2%)of dysphagia when 1.5 years old,6 cases(15.8%)of malnutrition.After multidisciplinary collaboration,the survival rate increased(57.1%vs.85.3%,P=0.013),and the incidence of anastomotic leakage decreased(46.4%vs.20.6%,P=0.03).Conclusion The quality of life of children with congenital esophageal atresia can be improved by multidisciplinary cooperation and standardized postoperative follow-up.