胸腔镜治疗低体质量食管闭锁患儿的短中期疗效评价:单中心临床经验

Short and Medium Term Efficacy Evaluation of Thoracoscopic Treatment of Low-weight Children with Esophageal Atresia:a Single-center Clinical Experience

目的对胸腔镜手术治疗低体质量食管闭锁患儿的临床疗效及短中期随访结果进行评价。方法回顾性分析2015年1月—2020年1月福建省妇幼保健院小儿外科收治的经胸腔镜治疗的46例食管闭锁患儿的临床资料,根据手术时体质量是否低于2500 g分为低体质量组(11例)和正常体质量组(35例)。对比两组的基线资料、手术时间、术中出血量、术后机械通气时间、术后胸腔引流时间、经胃管开始喂养时间、经口开始喂养时间、术后住院时间以及术后的并发症情况和术后3年随访的并发症情况。结果两组患儿手术时间、术中出血量、术后机械通气时间、术后胸腔引流时间、经胃管开始喂养时间、经口开始喂养时间、术后住院时间比较,差异无统计学意义(P>0.05)。低体质量组术后食管吻合口瘘发生率为18%,正常体质量组为8%,差异无统计学意义(χ^(2)=0.114,P=0.735)。低体质量组术后食管吻合口狭窄发生率为54%,正常体质量组为48%,差异无统计学意义(χ^(2)=0.119,P=0.730)。术后3年随访,低体质量组气管软化发生率为38%,高于正常体质量组的7%,差异无统计学意义(χ^(2)=2.903,P=0.088);低体质量组胃食管反流发生率为50%,正常体质量组为20%,差异无统计学意义(χ^(2)=1.588,P=0.208);低体质量组有症状性食管狭窄发生率为50%,正常体质量组为40%,差异无统计学意义(χ^(2)=0.011,P=0.916)。结论低体质量患儿行胸腔镜治疗食道闭锁的术中和术后结果与正常体质量患儿相当。低体质量不再是限制食道闭锁患儿行胸腔镜手术的条件,在手术者拥有丰富的胸腔镜操作经验情况下是可行的选择。

Objective To evaluate the clinical efficacy of thoracoscopic surgery in the treatment of low-weight chil⁃dren with esophageal atresia and the short and medium term follow-up results.Methods The clinical data of 46 chil⁃dren with esophageal atresia treated by thoracoscopy in the Pediatric Surgery Department Of Fujian Maternal And Child Health Hospital from January 2015 to January 2020 were retrospectively analyzed.According to whether the weight at the time of surgery was less than 2500 g,they were divided into low weight group(11 cases)and normal weight group(35 cases).The baseline data,operation time,intraoperative bleeding,postoperative mechanical ventila⁃tion time,postoperative thoracic drainage time,feeding time through gastric tube,feeding time through mouth,postop⁃erative hospitalization time,postoperative complications and complications of 3-year follow-up of the two groups were compared.Results The operative time,intraoperative blood loss,postoperative mechanical ventilation time,postopera⁃tive chest drainage time,gastric tube feeding time,oral feeding time and postoperative hospital stay between the two groups were compared,the difference was not statistically significant(P>0.05).The incidence of postoperative esopha⁃geal anastomotic fistula was 18%in the low weight group and 8%in the normal weight group,the difference was not statistically significant(χ^(2)=0.114,P=0.735).The incidence of postoperative esophageal anastomotic stenosis was 54%in the low weight group and 48%in the normal weight group,the difference was not statistically significant(χ^(2)=0.119,P=0.730).The incidence of tracheomalacia was 38%in the low weight group and 7%in the normal weight group,the difference was not statistically significant(χ^(2)=2.903,P=0.088).The incidence of gastroesophageal reflux was 50%in the low weight group and 20%in the normal weight group,the difference was not statistically significant(χ^(2)=1.588,P=0.208).The incidence of symptomatic esophageal stenosis was 50%in the low weight group and 40%in the normal weight group,the difference was not statistically significant(χ^(2)=0.011,P=0.916).Conclusion The intraoperative and postoperative outcomes of thoracoscopic treatment of esophageal atresia in low-weight children are comparable to those in normal-weight children.Low body weight is no longer a condition that restricts thoracoscopic surgery for chil⁃dren with esophageal atresia,and it is a feasible option when the operator has rich experience in thoracoscopy.