CAJ | 학술논문

目的：长段缺失型食管闭锁患儿在出生后不同时期根据患儿不同病情采取不同手术方案,通过近远期的结果分析,总结治疗经验,制定相应的治疗策略。方法我院2003年1月至2013年6月,收治长段型食管闭锁(LEA)29例,男20例,女9例。其中Ⅰ型食管闭锁(EA)10例,Ⅲa 型19例。Ⅰ型 EA中施行的手术方法包括胃管成形代食道、胃代食道、近端食管翻转成形术以及食管端端吻合术；Ⅲa型 EA中采取的手术方法包括结肠代食道术、食道肌层螺旋形切开延长、以及一期端端吻合术。结果27例治愈出院,死亡1例,1例术后家属放弃治疗死亡。术后近期并发症中肺部感染13例,吻合口漏7例,吻合口狭窄9例,反复气胸1例,胸腔感染5例,应激性溃疡消化道出血1例,术后出院前行钡餐检查提示7例存在胃食管反流。随访2个月至10年,术后3个月内12例存在呕吐现象,3个月后则呕吐症状明显好转。术后1年以上得到随访14例,2例胃管成形代食道以及2例胃代食道患儿进食速度快时易出现胸闷症状。食管泛影葡胺造影9例存在胃食管反流,但24 h食管pH 监测7例中,4例存在夜间反流,均未行抗反流手术。结论食管本身作为替代物优势明显,术后功能建立快,远期效果较好；结肠代食道是成熟安全的手术方法,对于早期施行食管颈部造瘘和胃造瘘的患儿可作为首选的治疗方法。胃代食道和胃管成形代食道可作为新生儿期的手术选择,但应慎重考虑。
목적：장단결실형식관폐쇄환인재출생후불동시기근거환인불동병정채취불동수술방안,통과근원기적결과분석,총결치료경험,제정상응적치료책략。방법아원2003년1월지2013년6월,수치장단형식관폐쇄(LEA)29례,남20례,녀9례。기중Ⅰ형식관폐쇄(EA)10례,Ⅲa 형19례。Ⅰ형 EA중시행적수술방법포괄위관성형대식도、위대식도、근단식관번전성형술이급식관단단문합술；Ⅲa형 EA중채취적수술방법포괄결장대식도술、식도기층라선형절개연장、이급일기단단문합술。결과27례치유출원,사망1례,1례술후가속방기치료사망。술후근기병발증중폐부감염13례,문합구루7례,문합구협착9례,반복기흉1례,흉강감염5례,응격성궤양소화도출혈1례,술후출원전행패찬검사제시7례존재위식관반류。수방2개월지10년,술후3개월내12례존재구토현상,3개월후칙구토증상명현호전。술후1년이상득도수방14례,2례위관성형대식도이급2례위대식도환인진식속도쾌시역출현흉민증상。식관범영포알조영9례존재위식관반류,단24 h식관pH 감측7례중,4례존재야간반류,균미행항반류수술。결론식관본신작위체대물우세명현,술후공능건립쾌,원기효과교호；결장대식도시성숙안전적수술방법,대우조기시행식관경부조루화위조루적환인가작위수선적치료방법。위대식도화위관성형대식도가작위신생인기적수술선택,단응신중고필。
Objective To explore the short-term and long-term postoperative outcomes and formulate individualized treatments for long-gap esophageal atresia (LEA)after birth.Methods From January 2003 to June 2013,29 LEA patients were admitted into our hospital.There were 20 boys and 9 girls.The types were isolated esophageal atresia (type Ⅰ,n=1 0 )and esophageal atresia with trachea-esophageal fistula (type Ⅲa,n=19).For type I patients,gastric tube esophagoplasty,gastric transposition,esophageal flap esophagoplasty and end-to-end esophageal anastomosis were performed respectively.For type Ⅲ a patients, esophageal replacement with colon, circular myotomy for esophagus lengthening and end-to-end esophageal anastomosis.Results Twenty-seven cases survived and two died.The postoperative complications were pneumonia (n=13),anastomotic leakage (n=7), stenosis (n=9),pneumothorax (n=1),chest infection (n=5)and digestive bleeding cause by stress ulceration (n=1 ).The gastro-esophageal reflux was found by contrast study before discharge in 7 cases.The overall follow-up period was 2 months to 10 years and 14 cases for over 1 year.And 12 cases vomited within 3 months and improved obviously later.Chest distress occurred in 4 cases during rapid ingestions. Gastric tube esophagoplasty (n= 2 ) and gastric transposition (n= 2 ) were performed.Gastric-esophageal reflux was found in 9 cases by contrast study.Among 7 cases of 24-hour esophageal pH monitoring,reflux appeared at midnight in 4 cases and underwent no anti-reflux operation.Conclusions For esophageal replacement,autologous esophagus has the best functions. Eesophageal replacement with colon is an effective treatment for cervical esophagostomy and gastrostomy.And gastric tube esophagoplasty and gastric transposition may be used discreetly in neonates with LEA.