CAJ | 학술논문

目的探讨经胸腔镜手术治疗先天性食管闭锁并食管气管瘘的手术经验及疗效.方法回顾性分析我院2010年1月至2014年1月间,运用经胸腔镜手术治疗先天性食管闭锁并食管气管瘘69例的临床资料.其中,男42例,女27例;日龄1～48 d;体重1.4～3.5 kg.术前均通过食管造影明确诊断,常规完成心脏及腹部超声检查.手术采用3孔法,在胸腔镜下结扎切断奇静脉,结扎或缝扎食管-气管瘘,游离近、远侧食管盲端,5-0可吸收线间断缝合食管完成吻合,术毕留置胸腔引流管.结果 69例患儿中63例在胸腔镜下一期完成食管吻合术,手术时间73～205min,平均(123±39)min;1例输浓缩红细胞0.2单位,余手术出血量均＜10 ml,未输血;术后呼吸机支持时间(2.7±2.3)d.4例行需行分期手术,中转开胸2例,术后吻合口漏9例,其中1例放弃治疗,余8例经保守治疗治愈.术后随访2个月～3年9个月,食管吻合口狭窄需扩张治疗的病例25例,分别予以沙氏探条扩张1～18次,1例重度胃食管反流,行腹腔镜下Nissen手术治愈.食管气管瘘复发4例(其中1例死亡,3例再次开胸手术修补治愈).本组死亡或放弃治疗6例.结论胸腔镜手术治疗先天性食管闭锁并食管气管瘘应用初期存在与手术技术相关并发症,选择适宜器械、加强腔镜操作训练与经验交流可缩短学习曲线.
목적 탐토경흉강경수술치료선천성식관폐쇄병식관기관루적수술경험급료효.방법 회고성분석아원2010년1월지2014년1월간,운용경흉강경수술치료선천성식관폐쇄병식관기관루69례적림상자료.기중,남42례,녀27례;일령1～48 d;체중1.4～3.5 kg.술전균통과식관조영명학진단,상규완성심장급복부초성검사.수술채용3공법,재흉강경하결찰절단기정맥,결찰혹봉찰식관-기관루,유리근、원측식관맹단,5-0가흡수선간단봉합식관완성문합,술필류치흉강인류관.결과 69례환인중63례재흉강경하일기완성식관문합술,수술시간73～205min,평균(123±39)min;1례수농축홍세포0.2단위,여수술출혈량균＜10 ml,미수혈;술후호흡궤지지시간(2.7±2.3)d.4례행수행분기수술,중전개흉2례,술후문합구루9례,기중1례방기치료,여8례경보수치료치유.술후수방2개월～3년9개월,식관문합구협착수확장치료적병례25례,분별여이사씨탐조확장1～18차,1례중도위식관반류,행복강경하Nissen수술치유.식관기관루복발4례(기중1례사망,3례재차개흉수술수보치유).본조사망혹방기치료6례.결론 흉강경수술치료선천성식관폐쇄병식관기관루응용초기존재여수술기술상관병발증,선택괄의기계、가강강경조작훈련여경험교류가축단학습곡선.
Objective To evaluate our experiences in thoracoscopic repair of congenital esophageal atresia with tracheoesophageal fistula (EATEF) in neonates.Methods The 3-trocar thoracoscopic procedures of esophageal anastomosis and fistula ligation were performed for 69 neonates from January 2010 to January 2014.There were 42 males and 27 females with an age range of 1-48 days and a body weight of 1.4-3.5 kg.In all cases,the diagnosis was made based on esophageal radiological contrast plus echocardiography and abdominal ultrasonography.At the end of procedure,a chest tube was implanted.Results A total of 69 patients underwent thoracoscopic repair.And 63 had one-stage repair successfully.Two operations were converted into open thoracotomy and 4 cases had to be staged due to a long gap between 2 esophageal segments.The average operative duration was 123-± 39 (73-205)min.The amount of bleeding was ＜10 ml except for 40 ml in one case.The mean length of mechani cal ventilation was (2.7 ± 2.3) days.Nine cases had anastomotic leak.The follow-up period was 2-45 months.And 25 neonates developed anastomotic stricture and required esophageal dilatation 1 to 18 times.Recurrent fistula between esophagus and trachea developed in 4 cases.Later one case required laparoscopic fundoplication.And six cases died.Conclusions The thoracoscopic procedure is both safe and effective in the treatment of EATEF.Initial attempts result in a higher incidence of such complications as stricture and leak.Better outcomes may be achieved with technique refinements.