摘要
目的分析Ⅲ型食管闭锁术后吻合口漏的发生及影响因素，探讨其诊断、治疗及预后。方法回顾2000-2007年来我院进行根治性手术的53例Ⅲ型食管闭锁患儿的临床资料，对食管闭锁术后吻合口漏的发生率、影响因素及诊断治疗进行回顾性分析。结果53例患儿中，男38例（71．7％），女15例（28．3％），术后出现吻合口瘘21例（39．6％），其中Ⅲa型中出现吻合瘘者14例（14／21），Ⅲb型7例（7／32），两组间差异存在统计学意义。21例中严重泄漏15例，Ⅲa型10例（10／21），Ⅲb型5例（5／32）；轻度泄漏6例Ⅲa型4例（4／21），Ⅲb型2例（2／32），经检验差异无统计学意义。21例发生吻合口漏者，出生体重〉2500g者有9例（9／32），2000-2500g者10例（10／17），〈2000g者2例（2／4），差异无统计学意义；21例中无伴发畸形15例（15／37），伴发中度畸形5例（5／12），伴发严重畸形1例（1／3），差异无统计学意义。共有5例患儿死亡，仅1例与吻合口漏有关。其余吻合口漏的患儿，均经非手术治疗痊愈。发生吻合口漏的21例患儿，狭窄指数为0．604±0．023，32例无吻合口漏者狭窄指数为0．519±0．028（P=0．034〈0．05）。11例患儿因吻合口狭窄接受食管扩张术，其中吻合口漏者6例，无发生泄漏者5例（P〉0．05）。结论食管闭锁术后吻合口漏的发生率与食管盲端间距离密切相关。本并发症经非手术治疗多可治愈，在没有发生吻合口完全断裂的情况下，不提倡再次手术修补。
Objective To analyze the causes of the postoperative leakage of esophageal anastomosis in patients with esophageal atresia （EA） of type Ⅲ and to investigate the diagnosis, treatment and prognosis of the leakage. Methods Between 2000 and 2007, 53 patients with esophageal atresia of type Ⅲ who underwent esophageal anastomosis in this institution were retrospectively analyzed. The incidence of leakage, the potential causes, the diagnosis and treatment of this complication were recorded and analyzed. Results In all the 53 patients, 38 were males （71.7%） and 15 were females （28. 3%）, with the mean birth weight of 2. 53 ＋ 0. 63 kg. Among them, 21 （39. 62%） suffered leakage. According to Gross classification, 14 cases were type Ⅲ a and 7 were type Ⅲ b, which had significant difference （P〈0, 05）. In 15 patients suffering severe leakage, 10 cases were type Ⅲa and 5 were Ⅲb; while in 6 patients suffering minor leakage, 4 cases were type Ⅲa and 2 were Ⅲb. Among 21 patients with leakage, the birth weight of 9 cases （9/32） were beyond 2500 g, 10 cases （10/17） were between 2 000 g and 2 500 g, and 5 cases （5/32） were less than 2 000 g. In the 21 patients with leakage, 15 cases were without any associated abnormities, 5 cases were with moderate associated abnormities, and only 1 case was with severe associated abnormities. Five patients died during hospitalization, but only one died of leakage. All the other patients with leakage accepted non-operative therapy and recovered well. The anastomosis stricture index of the patients with leakage was 0. 604 ±0. 023, which was significantly higher than that in patients without leakage （0. 519 ±0. 028）. Eleven patients （11/53） accepted esophageal dilatation for anastomosis stricture, in whom 6 cases had leakage while the other 5 without, which showed no statistical difference. Conclusions The incidence of esophageal anastomosis leakage is related to the distance between two ends of the esophagus. All leakage except for complete anastomotic disruption could be managed by non-surgical therapy, such as thorax drainage and parenteral nutrition, until spontaneous closures formed in the next 1 to 3 weeks.
出处
《中华小儿外科杂志》
CSCD
北大核心
2008年第12期707-710,共4页
Chinese Journal of Pediatric Surgery
基金
卫生部属（管）临床学科重点项目一新生儿重症畸形的诊断和治疗
