Ⅰ型先天性食管闭锁的临床治疗经验

Clinical experiences of treating type I congenital esophageal atresia

摘要:

目的：总结Ⅰ型先天性食管闭锁（congenital esophageal atresia，CEA）临床诊疗经验。方法：7例Ⅰ型CEA患者中男5例，女2例，胎龄为34.85～39.30周，出生体质量为2 100～3 000 g，其中早产儿1例，低体质量儿4例；合并先天性心血管畸形4例，肠道畸形1例，未合并畸形2例。入院后行胃造瘘术，术后2周行结肠代食管治疗。随访术后并发症、进食情况、生长发育等。结果：7例患者中1例患者胃造瘘后出现核黄疸未再次手术，其余6例2周后均行结肠代食管手术治疗，术后1例患者合并严重肺部感染脱机困难，其余5例术后均无吻合口瘘，随访1～5年进食正常，未见吻合口处狭窄，无胃食管返流，生长发育与同龄儿无异。结论：结肠代食管术后并发症低，总体治疗效果满意，可作为治疗Ⅰ型CEA的一种可靠的方法。

Abstract:

Objective：To summarize our experiences of diagnosing and treating typeⅠcongenital esophageal atresia. Methods：A retro－spective review was performed on 7 patients with typeⅠcongenital esophageal atresia. There were 5 males and 2 females with a gesta－tional age of 34.85－39.30 weeks and a birth weight of 2 100 to 3 000 grams. There were 1 premature infant and 4 low-birth weight infants. Four patients were congenital heart disease and one was congenital intestine malformation. Gastrostomy was performed af－ter typeⅠcongenital esophageal atresia being confirmed；then esophageal replacement with colon was conducted after 2 weeks. Fol－low-ups were implemented for postoperative complications，feedings growth and development. Results：One week after gastrostomy，one patient gave up the surgery due to kernicterus，the other 6 patients were treated by esophageal replacement with colon. After the surgery，one patient had serious pulmonary infection and couldn’t be withdrawn from mechanical ventilation；the other five were dis－charged from hospital without anastomosis orifice fistula. Patients were followed up for 1 to 5 years without suffering from anastomosis orifice stenosis and gastroesophageal reflux. Conclusion：Eesophageal replacement with colon is an effective treatment for typeⅠcon－genital esophageal atresia as lower complications.