CAJ | 학술논문

目的探讨Ⅲ型食管闲锁的早期诊断与治疗方法.方法回顾性分析我院2006年08月～2008年07月收治的16例Ⅲ型食管闭锁患儿的临床资料.所有病例均经造影证实,采用经胸膜外入路行食管气管瘘结扎切断、食管端端吻合术,部分病例加行Livaditis法环切食管肌层,延长食管减小张力后再行食管端端吻合.结果 16例均行手术治疗,全部治愈.1例术后吻合口瘘行二次修补手术后治愈出院;1例术后吻合口瘘,经抗感染、营养支持、充分引流后瘘口愈合.术后随访6个月～2年,其中术后吻合口瘘保守治疗治愈者1年后并发肺部感染死亡,余11例进食良好.结论早期诊断、及时手术、术后护理及并发症的防治对提高先天性食管闭锁患儿的存活率有重要作用.尤其减少吻合口张力对防止吻合口瘘起决定性作用.术中避免胸膜破裂对呼吸功能的恢复和预后起重要作用.早期拔除放置于吻合口旁的胸膜外引流管有利于吻合口的愈合.
목적 탐토Ⅲ형식관한쇄적조기진단여치료방법.방법 회고성분석아원2006년08월～2008년07월수치적16례Ⅲ형식관폐쇄환인적림상자료.소유병례균경조영증실,채용경흉막외입로행식관기관루결찰절단、식관단단문합술,부분병례가행Livaditis법배절식관기층,연장식관감소장력후재행식관단단문합.결과 16례균행수술치료,전부치유.1례술후문합구루행이차수보수술후치유출원;1례술후문합구루,경항감염、영양지지、충분인류후루구유합.술후수방6개월～2년,기중술후문합구루보수치료치유자1년후병발폐부감염사망,여11례진식량호.결론 조기진단、급시수술、술후호리급병발증적방치대제고선천성식관폐쇄환인적존활솔유중요작용.우기감소문합구장력대방지문합구루기결정성작용.술중피면흉막파렬대호흡공능적회복화예후기중요작용.조기발제방치우문합구방적흉막외인류관유리우문합구적유합.
Objective To investigate the early diagnosis and therapy of Type []Congenital Esophageal Atresia(CEA). Method A retrospective analysis had been adopted to the clinical materials of 16 cases of type Ⅲ CEA during August 2006 to July 2008 in our hospital. All cases had been confirmed by angiog-raphy. The Tracheoesophageal Fistula (TF) through outerpleura path were ligated and the anastomosis operation was done. Some cases were added the procedure of Lovaditis for cutting the t.muscularis oesophagi before the anastomosis opertation. Results All 16 cases had been done the surgery and all were cured. Among all the cases, one was conducted a repair operations before fully cured, one was fully cured after anti-infection, nutrition support and fully postoperative drainage. All cases were tracked for 6 months to 2 years. One case died for the infection of lung and the other 11 cases had been in good condition. Conclusion Early di-agonosis, prompt surgery, good postoperative nursing and the preventive and therapy of complication were of great importance in improving the survival rate of CEA. In particular, the reducing of anastomotic had decisive effect to anastomotic leakage. The avoidance of pleura rupture was significant for the recovery and prognosis. The early extraction of the pipe of outer pleural of the postoperative drainage near the anstomosis was beneficial for the recovery of the anastomosis.