胸腔镜矫治Ⅲ型食管闭锁

摘要

目的 总结胸腔镜手术矫治Ⅲ型食管闭锁治疗经验,探讨其可行性及临床疗效.方法 回顾性分析24例新生儿Ⅲ型先天性食管闭锁患儿接受胸腔镜手术的临床资料,男12例,女12例,Ⅲa型9例,Ⅲb型15例.体质量1.9～3.6 kg,平均2.56 kg.年龄出生后1 h～8天,平均2.5天.术前均行食管造影确诊,常规行超声心动图及腹部超声检查.结果 造影确诊食管闭锁Ⅲ型,3例提示近端盲端在胸2椎体水平,21例在胸3、4椎体水平,腹腔肠道可见充气.胸腔镜下完成手术23例,仅1例患儿术中氧合不能维持中转.手术时间110～280 min.前14例患儿奇静脉弓切断;后10例患儿进行了保留,并将其覆盖,或壁胸膜覆盖食管气管瘘残端.1例Ⅲa型不能一期吻合,家长放弃.吻合口瘘5例,经保守治愈.早期食管气管瘘复发2例,置鼻空肠管二期手术治愈.吻合口狭窄需要扩张5例,平均扩张2次.结论 Ⅲ型食管闭锁经胸腔镜手术可行,手术效果好,手术美观;术中可保留自身奇静脉弓并将其或壁胸膜覆盖食管气管瘘残端,可能减少食管气管瘘复发.%Objective Conclusion thoracoscope surgery clinical data and correcting Ⅲ esophageal atresia(EA) and discuss the feasibility and clinical effect.Methods 24 cases confirmed the third type of esophageal atresia were retrospectively analyzed.There were 12 male and 12 female.9 cases were type Ⅲa EA and 15 cases were type Ⅲb EA.The weights were from 1.9 kg to 3.6 kg,mean weight was 2.56 kg.The age were from born to 8 days,the mean age was 2.5 days.Before operation esophageal contrast study was carried out,also ultrasonography was routinely used to evaluate heart and abdominal viscera.Results The diagnosis of third type EA was confirmed by esophageal contrast study with a blind proximal end of the esophagus and air inflation in the gut.There were 3 cases with proximal blind pouch at the 2nd vertebrate level and the other 21 cases at the 3rd to 4th vertebrate level.All the cases except one just beginning transferred to open operation because hypo-SpO2 was corrected by thoracoscopic operation.The operation time was from 110 min to 280 min,and the mean time was 120 min.The azygos vein in the former 14 cases divided and was preserved in the latter 10 cases.So the stump of the tracheoesophageal fistula (TEF) of the latter 10 cases were covered by the preserved azygos vein or plus the parietal pleura.One Ⅲa type EA could not be repaired by the radical operation and abandoned.5 cases with anastomotic leakage were cured by conserved tactics.2 cases with early TEF recurrence were initially supported by enteral nutrition by putting nasogastric jejunal tube and corrected by the 2nd stage operation.5 cases with anastomotic stricture were dilated by two times.Conclusion It is feasible to correct the Ⅲ type EA by thoracoscopic operation with good results and nice appearances.The preserved azygos vein to cover the stump of the TEF may contribute to reduce the recurrence of TEF.