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目的比较胸腔镜手术与开胸手术治疗先天性食管闭锁并气管食管瘘的疗效差异。方法回顾性分析2008年6月至2016年10月首都儿科研究所附属儿童医院收治的Ⅲ型食管闭锁59例患儿的临床资料,其中胸腔镜手术组(A组)30例,开胸手术组(B组)29例。A组食管闭锁ⅢA型12例,ⅢB型18例;B组ⅢA型14例,ⅢB型15例。对比两组患儿的术前资料及术后恢复情况,比较腔镜手术与开放手术相关并发症、治愈率及复发率。结果两组患儿的日龄[(3.2±0.2)d vs.(3.4±0.5)d,P=0.910],体重[(2.83±0.63)kg vs.(2.81±0.64)kg,P=0.910],先心病比例[(18例(60.0%)vs.19例(65.5%),P=0.661]差异无统计学意义,具有可比性。A组除1例33周早产儿重症肺炎,麻醉不能耐受,一期仅行胸腔镜下气管食管瘘修补术,延期3周胸腔镜下完成食管端端吻合术,其余29例均一期完成气管食管瘘修补及食管吻合术,无中转手术。B组27例一期手术完成气管食管瘘修补及食管吻合术,2例因食管盲端间距过长,行食管气管瘘缝扎,胃造瘘术,延期行经胸食管吻合术。与开胸手术组比较,A组手术时间[207(142,240)min vs.170(150,170)min,P=0.058],术后呼吸机使用时间[120(72,168)h vs.72(48,180)h,P=0.086];术后住院时间[14.00(12.75,26.25)d vs.14.00(10.00,14.50)d,P=0.100],差异无统计学意义。A组的治愈率(93.3%vs.82.8%,P=0.209),术后并发症吻合口漏发生率高于B组[7例(23.3%)vs.3例(10.3%),P=0.299],但差异无统计学意义;吻合口狭窄发生率大致相同(36.7%vs.34.5%,P=0.861)。A组患者术后1例气管食管瘘复发,B组无复发,差异无统计学意义(P>0.05)。结论胸腔镜手术治疗先天性食管闭锁合并气管食管瘘是安全可行的,要求术者具备熟练的微创手术技术和相关手术技巧。
Objective To compare the efficacy of thoracoscopic surgery and thoracotomy in the treatment of congenital esophageal atresia and tracheal esophageal fistula. Methods The clinical data of 59 patients with type Ⅲ esophageal atresia admitted to Children’s Hospital Affiliated to Capital Institute of Pediatrics from June 2008 to October 2016 were retrospectively analyzed. Thoracoscopic surgery group (group A) 30 cases, thoracotomy group (B group) in 29 cases. In group A, esophageal atresia type ⅡA was 12 cases, type ⅢB was 18 cases, group B was ⅢA 14 cases, type ⅢB 15 cases. The preoperative data and postoperative recovery of two groups of children were compared. The complication, cure rate and recurrence rate between endoscopic surgery and open surgery were compared. Results The age of the two groups was significantly higher than that of the control group [(3.2 ± 0.2) d vs. (3.4 ± 0.5) d, P = 0.910], body weight (2.83 ± 0.63) kg vs. (18 cases (60.0%) vs.19 cases (65.5%), P = 0.661] There was no significant difference between group A and group A. In addition to 1 case of 33 cases of severe pneumonia in preterm infants in group A, anesthesia was not tolerated Thoracoscopic tracheal esophageal fistula repair was performed only in one phase, delayed thoracoscopic esophageal end anastomosis was performed in 3 weeks, and the remaining 29 cases were treated with tracheo-esophageal fistula repair and esophageal anastomosis without transit in group B. Group B In one case, tracheoesophageal fistula repair and esophageal anastomosis were performed in one case, 2 cases had esophageal fistula suture, gastrostomy and delayed esophageal anastomosis due to the long interval of esophageal blind end, The operative time of group A was 207 (142,240) min vs 170 (150,170) min, P = 0.058], and the duration of ventilator after operation was 120 (72,168 h vs 72.2 (48,180) h, P = 0.086] The average hospital stay was 14.00 (12.75, 26.25) d vs 14.00 (10.00, 14.50) d, P = 0.100], and the difference was not statistically significant. The cure rate in group A (93.3% vs 82.8%, P = 0.209) The incidence of postoperative anastomotic leakage was higher in group B than in group B (7 cases (23.3% vs.3.3%, P = 0.299), but the differences The incidence of anastomotic stenosis was about the same (36.7% vs.34.5%, P = 0.861) .After tracheal esophageal fistula recurred in group A, there was no recurrence in group B, the difference was not statistically significant (P> 0.05 ) Conclusions Thoracoscopic surgery for the treatment of congenital esophageal atresia combined with tracheal esophageal fistula is safe and feasible, requiring the surgeon to have a skilled minimally invasive surgical technique and related surgical techniques.