CAJ | 학술논문

目的探讨经颈胸腹三切口胃卷管上提术治疗Ⅲa型食管闭锁的技术可行性及早期效果.2010年1月至2011年10月共6例于新生儿期Ⅰ期行经颈胸腹三切口胃卷管上提治疗Ⅲa型食管闭锁病例.方法结扎、切断食管-气管瘘(Ⅲa型),于胃小弯处切开胃前后壁,缝合卷管,并将远端食管盲端及胃卷管由食管裂孔提至后纵膈；于胸骨上方右侧颈部横切口,寻找食管近盲端；将远端食管及卷管胃上提至颈部,与近端食管行端端吻合术.回顾性分析手术时间、呼吸支持的时间、术后恢复情况和并发症及术后早期随访情况.结果所有患儿均在新生儿期Ⅰ期完成食管吻合,无围手术期死亡.食管闭锁近远端距离平均值为4.5(4～6)cm,平均手术时间270(200～390) min,平均术中出血25(10～50)ml,其中2例因肛门闭锁同期行结肠造瘘术；平均脱离呼吸机天数为13(5～18)d,术后禁食时间为9(7～12)d.2例患儿出现卷管漏,保守治疗后治愈；平均住院天数为32(26～39)d;所有患儿均随访4～20个月,暂无患儿出现吻合口狭窄和胃食管反流.结论经颈胸腹三切口胃卷管上提术可作为新生儿期Ⅰ期治疗Ⅲa型食管闭锁的一种手术方式.
목적 탐토경경흉복삼절구위권관상제술치료Ⅲa형식관폐쇄적기술가행성급조기효과.2010년1월지2011년10월공6례우신생인기Ⅰ기행경경흉복삼절구위권관상제치료Ⅲa형식관폐쇄병례.방법 결찰、절단식관-기관루(Ⅲa형),우위소만처절개위전후벽,봉합권관,병장원단식관맹단급위권관유식관렬공제지후종격；우흉골상방우측경부횡절구,심조식관근맹단；장원단식관급권관위상제지경부,여근단식관행단단문합술.회고성분석수술시간、호흡지지적시간、술후회복정황화병발증급술후조기수방정황.결과 소유환인균재신생인기Ⅰ기완성식관문합,무위수술기사망.식관폐쇄근원단거리평균치위4.5(4～6)cm,평균수술시간270(200～390) min,평균술중출혈25(10～50)ml,기중2례인항문폐쇄동기행결장조루술；평균탈리호흡궤천수위13(5～18)d,술후금식시간위9(7～12)d.2례환인출현권관루,보수치료후치유；평균주원천수위32(26～39)d;소유환인균수방4～20개월,잠무환인출현문합구협착화위식관반류.결론 경경흉복삼절구위권관상제술가작위신생인기Ⅰ기치료Ⅲa형식관폐쇄적일충수술방식.
Objective To investigate the feasibility of applying gastric-tube pull-up (GTPU) in the treatment of type Ⅲ a esophageal atresia in the neonatal period.Methods From Jan.2010 to Oct.2011,GTPU was used to treat 6 newborns with type Ⅲa esophageal atresia diagnosed by upper gastrointestinal radiography.Their clinical data including operative time,blood loss,duration of mechanical ventilator supporting were retrospectively summarized and analyzed in this study.The operation was divided into four main parts.The tracheo-esophageal fistula was divided and ligated.The gastric lesser curvature was cut open and a gastric-tube was made; then the tube was pulled up to the thorax by the posterior mediastinum approach.After the proximal end was searched atthe neck,the tube was brought into the neck via the trans-hiatal route to make an end-to-end anastomosis.Results All operations were performed successfully during the neonatal period with no mortality.The mean distance between the two blind- ends was 4.5 cm (ranging from 4～6); the average operative time was 270mins (ranging from 20～390):and the mean volume of blood loss was 25 mls (ranging from 10～50).Two patients underwent colostomy at the same time due to impferforate anus.The mean time to wean from mechanical ventilation was 13 d (ranging from 5～18).The duration of fasting was 9 d (ranging from 7～ 12).2 patients had anastomotic leakage but healed after conservative treatment.The average length of hospitalization was 32 d (26～39).At follow up(4 to 20 months),no anastomotic stenosis or gastroesophageal reflux was found in any of the cases.Conclusions Gastric-tube pull-up is one of the choices for treating type Ⅲ a esophageal atresia as one-stage operation in the neonatal period.