i型食管闭锁的治疗策略(附10例报告

Q4 Medicine

中华小儿外科杂志 Pub Date : 2019-11-15 DOI:10.3760/CMA.J.ISSN.0253-3006.2019.11.008

Wei Fan, Jinshi Huang, Kuai Chen, J. Tao, Zhiwen Liu, Meihan Xu, Xiang-hui Zeng, Gan Liang, Yang Zhi

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引用次数: 0

摘要

目的探讨通过自然生长和张力延伸治疗Ⅰ型食管闭锁的治疗策略。方法选取2012年1月~ 2017年1月-Ⅰ型EA患儿10例。有五个男孩和五个女孩。产后胃管插入困难，经食管造影后临床诊断为-Ⅰ型EA。出生后一个月内，行腹腔镜胃造口术。术中通过食道x线片测量食管近端与远端距离。并通过胃造口提供营养液。唾液经食管近端重新吸收，定期测量食管生长情况。食管伸展是通过自然生长和张力伸展来实现的。因此，延迟了胸腔镜胃食管造口术。结果2例胸腔镜食管吻合均为自然生长吻合。完成年龄分别为153天和151天。在另外8例中，在出生后12周，食管近端和远端之间的距离仍然大于4只脊椎动物的总长度。应用张拉术促进食管生长，行胸腔镜胃食管造口术，术后行食管扩张术缓解食管狭窄。开始食管内延长时，平均年龄为(174.3±86.6)(92 ~ 280)天，食道端间平均椎体数为(5.1±0.5)(4.5 ~ 6.0)。延长时间为(49.0±16.2)(28 ~ 69)d。术后第7天，食管造影显示食管吻合口瘘(n=2)。两例均经保守治疗治愈。不同程度的食管狭窄(n=10)需要扩张食管。随访期间，所有患儿生长发育良好。结论通过食管自然生长和张力延伸促进食管扩张，减少吻合前手术创伤和术后粘连。胸腔镜允许一个独特的放血手术领域，以尽量减少手术创伤。治疗后恢复良好。这种有前途的治疗方法值得广泛推广。关键词:食管闭锁;胸腔镜;食管扩展

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Management strategies of type-I esophageal-atresia: a report of 10 cases

Objective To explore the management strategies of type Ⅰ esophageal atresia (EA) through natural growth and tension-extension. Methods From January 2012 to January 2017, a total of 10 children of type-Ⅰ EA were recruited.There were 5 boys and 5 girls.Difficult postnatal insertion of gastric tube prompted a clinical diagnosis of type-Ⅰ EA after esophagography.Within a month after birth, laparoscopic gastrostomy was performed.During operation, the distance between proximal and distal esophagus was measured on esophageal radiography.And nutrient liquid was supplied via gastrostomy.Saliva was reabsorbed through proximal esophagus and esophageal growth measured regularly.Esophageal extension was achieved through natural growth and tension-extension.Thus thoracoscopic gastroesophagostomy was delayed. Results Two cases of thoracoscopic esophageal anastomosis were achieved through natural growth.The completion ages were 153 and 151 days respectively.In another eight cases, the distance between proximal and distal esophagus was still greater than the total length of four vertebrates at 12 weeks post-birth.Tension-extension was applied for promoting the growth of esophagus and thoracoscopic gastroesophagostomy performed .And esophagectasia was performed postoperatively for counteracting esophageal stenosis.When starting endo-esophogeal lengthening, the mean age was (174.3±86.6) (92-280) days and the mean vertebral number between esophogeal ends (5.1±0.5)(4.5-6.0). And the extended time was (49.0±16.2) (28-69) days.At Day 7 postoperatively, esophogeal contrasting radiography revealed esophogeal anastomotic fistula (n=2). Both cases were cured after conservative measures.Esophogeal stenosis of varying degrees (n=10) required esophogeal dilatation.During follow-ups, all children had excellent growth and development. Conclusions Promoting esophageal extension through natural growth and tension-extension reduces pre-anastomotic surgical trauma and postoperative adhesion.Thoracoscope allows a distinct exsanguine operative field for minimizing surgical trauma.The recovery is satisfactory after treatment.This promising treatment is worth a wider popularization. Key words: Esophageal atresia; Thoracoscopes; Esophageal extension

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来源期刊

中华小儿外科杂志 Medicine-Pediatrics, Perinatology and Child Health

CiteScore

0.40

自引率

0.00%

发文量

8707

期刊介绍： Chinese Journal of Pediatric Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1980 and is included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences) and CSCD Chinese Science Citation Database Source Journal (including extended version). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. Chinese Journal of Pediatric Surgery enjoys a high reputation and influence in the academic community. The articles published in this journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.