新生儿Ⅰ期胃代食管术治疗长段型食管闭锁

摘要

Objective To explore the application and efficacy of one-stage gastric transposition in long-gap esophageal atresia.Methods 11 patients of long-gap esophageal atresia who received one-stage gastric transposition treatment from March 2008 to December 2013 were analyzed.8 male and 3 female babies were included in the study.The diagnosis was made based on esophageal radiography.And there were 2 cases of type Ⅰ and 9 cases of type Ⅲ a.Results All procedures were completed,9 cases were cured,1 case died and 1 case refused further treatment after operation.6 cases developed pneumonia postoperatively,2 cases had signs of stoma leakage.All cases were followed up for 6 months to 5 years.3 cases had anastomotic stricture and they were cured by balloon dilation.6 cases had mild gastroesophageal reflux but no anti-reflux procedure was needed.And gastroesophageal reflux symptoms were improved by smaller meals and appreciate the feeding treatment.Conclusion One-stage gastric transposition is feasible and acceptable in treating long-gap esophageal atresia in neonates,it can avoid staging operation,shorten the treatment period,and help to improve the cure rate.%目的 探讨Ⅰ期胃代食管术治疗长段型食管闭锁的疗效.方法 对2008年3月至2013年12月采用Ⅰ期胃代食管术治疗的11例长段型食管闭锁进行回顾性分析,其中男8例,女3例.入院后行食管造影确诊,其中Ⅰ型2例,Ⅲa型9例.结果 所有患儿均顺利完成手术.9例治愈出院,1例死亡,1例家长放弃治疗.术后6例有严重肺炎,近期吻合口瘘2例.随访6个月至5年,吻合口狭窄3例,均行食管扩张术治愈,轻度胃食管反流6例,均未行抗反流手术,采用少量多餐及体位喂养治疗后症状缓解.结论 新生儿期采用Ⅰ期胃代食管术治疗长段型食管闭锁临床可行,避免了分期手术,缩短了治疗周期,有助于提高治愈率.