胸腔镜与开胸手术治疗Ⅲ型先天性食管闭锁伴有食管气管瘘的多中心回顾性研究

Thoracoscopic versus open repair for esophageal atresia and tracheoesophageal fistulas:a multicenter retrospective study

目的 比较胸腔镜与开胸手术治疗Ⅲ型食管闭锁伴食管气管瘘的临床疗效。方法 回顾性分析在南方医科大学珠江医院及中山市博爱医院小儿外科治疗的Ⅲ型先天性食管闭锁手术临床资料,分为开胸组及腔镜组,对两组患儿的一般情况、围手术期情况、术后治疗效果及术后并发症进行比较。结果 两家医院共完成135例Ⅲ型食管闭锁手术,排除合并严重畸形、中转开放及死亡病例,共纳入119例病例,其中开胸组68例,腔镜组51例。两组患儿性别、入院年龄、体重、术前上机率、食管闭锁分型差异均无统计学意义(均P>0.05),腔镜组需要更长的手术时间(t=5.414,P<0.001),两组患儿术后呼吸机辅助通气时间、开始进食时间及住院时间差异无统计学意义(均P>0.05);两组吻合口狭窄及吻合口漏发生率相当,开胸组伤口感染6例、胸廓畸形1例、食管气管瘘复发3例及贲门失弛缓1例,腔镜组食管气管瘘复发2例,气管憩室1例,胸腔镜可以降低术后切口感染的发生率(χ2=4.739,P=0.029)。结论 胸腔镜手术治疗Ⅲ型食管闭锁伴食管气管瘘是安全可行的,胸腔镜手术需要更长的手术时间,但并不会增加术后康复时间及手术并发症发生率,术后切口更加美观。

Objective To evaluate the advantage and disadvantages of the thoracoscopic versus open techniques for TypeⅡesophageal atresia(EA)and tracheoesophageal fistula(TEF).Methods A retrospective review of TypeⅡEA cases was performed from March 2010 to October 2022 at Zhujiang Hospital of Southern Medical University and Boai Hospital of Zhongshan.All patients were divided into two groups,thoracoscopic and open groups.The general characteristics,perioperative features,postoperative rehabilitation,and complications were summarized.Results A total of 135 cases of TypeⅡEA were completed in the two hospitals,and 119 cases were included,including 68 cases in the open group and 51 cases in the thoracoscopic group.There was no significant differences in gender,admission age,weight,preoperative rate of ventilator-assisted ventilation,or EA type between the open and thoracoscopic group(all P>0.05);while the average operation times in the thoracoscopic group were significantly longer than that in the open group(t=5.414,P<0.001).There was no statistical differences in tracheal extubation time,postoperative feeding time,or hospital stay between the two groups(P>0.05).The rates of anastomotic leakage and stenosis were similar in both groups(P>0.05).The open group has 6 cases of wound infection,1 case of thoracic deformity,3 cases of recurrent TEF,and 1 case of achalasia.In contrast,the thoracoscopy group has 2 cases of recurrent TEF and 1 case of tracheal diverticulum.Conclusion Thoracoscopic repair for TypeⅡEA and TEF is feasible and safe.The thoracoscopic group requires a longer operation time but does not increase the postoperative recovery time and the incidence of surgical complications.