胸骨后结肠食管成形术矫正食管闭锁后结肠食管吻合口裂口发生的因素消除

A. Kivva, M. Chepurnoy, B. M. Belik, Y. Tyshlek, M. Shtilman, A. A. Kivva, I. R. Chumburidze
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引用次数: 0

摘要

的目标。通过预防胸骨后隧道的结肠移植压迫和促进手术,使外科医生能够降低食管成形术后结肠-食管吻合口裂开的风险。材料和方法。对43例无胸骨病变的婴儿(男22例,女21例)进行超声检查。评估胸骨背角和胸骨柄上下部分的厚度。本文对15例婴儿胸骨柄背侧各部位肌肉的突出和结构进行了检查。分析了根据RF发明专利号2552095开发的方法对食道闭锁婴儿患者(8男7女)的治疗结果。9例患者在整个胸骨柄上开窗,6例儿童仅在胸骨柄上段开窗。x线对照检测移植结肠压迫。对于在有序尺度上测量的数据,使用Mann-Whitney U检验(M-W)评估被检查组中所讨论的变量之间的显著差异。胸骨柄上半部分(第一肋骨附着点上方)对移植物施加的压力最大,因为其厚度具有统计学意义(M-W=4.44;p<0.01),肌层覆盖较显著(M-W=6.71;p<0.001),面积更大(M-W=4.42;P <0.01),且明显倾斜。婴儿时期胸骨背角为164.9±0.8度。其值一致(M-W=2.66;P <0.01),且个体差异显著。基于收集到的数据,我们开发了一种独特的技术,用于胸骨后结肠食管成形术中切除胸骨柄,用于15例食管闭锁患者。所有病例均未发现结肠-食管吻合口裂开或移植压迫的迹象。建议的方法可以让外科医生在每个病例中评估胸骨后间隙的狭窄程度,并单独选择胸骨柄切除的范围,以消除导致食管闭锁胸骨后食管成形术后结肠-食管吻合口开裂的重要因素,从而方便手术,防止胸骨后隧道的移植压迫。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Elimination of factors contributing to the development of colo-esophageal anastomotic dehiscence following retrosternal colonic esophagoplasty performed for esophageal atresia correction
Aim. Development of methodology that would allow surgeons to decrease the risk of colo-esophageal anastomotic dehiscence following esophagoplasty through prevention of colonic transplant compression in the retrosternal tunnel and surgery facilitation.Material and methods. Ultrasound examination was carried out on 43 infants (22 boys and 21 girls) without sternal pathologies. The dorsal sternal angle and thickness of the upper and lower parts of the sternal manubrium were evaluated. The prominence and structure of muscular arrangement in various parts of the dorsal side of the sternal manubrium were examined in 15 infant patients. The results of treatment based on the method developed in accordance with the RF invention patent No. 2552095 were analyzed for infant patients (8 boys and 7 girls) suffering from esophageal atresia. 9 patients had fenestration of the sternal manubrium performed across its entire length, 6 children – in its upper segment only. X-ray control was used to detect colonic transplant compression. Significant difference between the variables in question in the examined groups was evaluated using the Mann-Whitney U test (M-W) for data measured on an ordinal scale.Results. The upper part of the sternal manubrium (above the attachment of the first rib) was found to exert the highest pressure on the transplant as it is statistically significantly thicker (M-W=4.44; p<0.01), being covered with a more prominent muscular layer (M-W=6.71; p<0.001) over a larger area (M-W=4.42; p<0.01) and considerably reclined. In infant age, the dorsal sternal angle is 164.9±0.8 degrees. Its value was consistently (M-W=2.66; p<0.01) higher in the girls' group with significant individual variations. Based on the collected data, an original technique was developed for individual approach to the resection of the manubrium sterni applied during retrosternal colonic esophagoplasty in 15 patients with esophageal atresia. No signs of colo-esophageal anastomotic dehiscence or transplant compression were revealed in any of those cases.Conclusion. The suggested method allows surgeons to assess in every case the narrowness of retrosternal space and individually select the scope of sternal manubrium resection to eliminate important factors contributing to the development of colo-esophageal anastomotic dehiscence after retrosternal esophagoplasty in cases of esophageal atresia thus facilitating the surgery and preventing transplant compression in the retrosternal tunnel.
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