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目的探讨先天性食管闭锁患儿手术治疗及术后并发症的处理。方法先天性食管闭锁患儿46例,男32例,女14例,低体质量儿(<2 kg)14例。首次住院治疗患儿平均入院日龄为(3.27±3.16)d。5例未手术患儿死亡,2例I型术中放弃治疗,余39例均行I期食管重建术。结果 39例行食管重建术患儿中2例I型术中放弃治疗,4例术后因家属放弃治疗自动出院,其余33例手术患儿术后治愈。术后近期并发症吻合口漏11例,经保守治疗后自愈10例,1例经再次手术吻合后痊愈;静脉营养并发症5例,经内科保守治疗后痊愈;远期并发症吻合口狭窄13例,行食管扩张6例,余随访无临床症状未行治疗,仍随访中。胃食管反流14例经内科治疗好转11例,3例行Nissen手术后好转。结论早诊断、加强围术期管理以及成熟的吻合技术是提高先天性食管闭锁患儿手术成功率的关键,营养支持是提高手术成功率的保障,食管闭锁手术后并发症的处理可提高患儿的生存质量。
Objective To investigate the surgical treatment of children with congenital esophageal atresia and the management of postoperative complications. Methods 46 cases of congenital esophageal atresia, 32 males and 14 females, 14 children with low birth weight (<2 kg). The average hospital admission date for the first hospitalization was (3.27 ± 3.16) d. 5 cases of non-surgical death of children, 2 cases of intraoperative I give up treatment, 39 cases were underwent stage I esophageal reconstruction. Results In the 39 cases of esophageal reconstructive surgery in 2 cases of type I surgery to give up treatment, 4 cases of spontaneous discharge due to family abandonment after treatment, and the remaining 33 cases of surgical treatment of children were cured. Short-term complications occurred in 11 cases with anastomotic leakage, 10 cases were cured by conservative treatment, 1 case was cured by re-operation and anastomosis, 5 cases of complications of intravenous nutrition were recovered after conservative treatment, long-term complications of anastomotic stenosis Thirteen patients underwent esophageal dilatation in 6 cases. No clinical symptoms were followed up for follow-up. Gastroesophageal reflux in 14 cases improved by medical therapy in 11 cases, 3 cases improved after Nissen surgery. Conclusion Early diagnosis, perioperative management and mature anastomosis are the keys to improve the success rate of surgical treatment of children with congenital esophageal atresia. Nutritional support is the guarantee to improve the success rate of operation. The treatment of postoperative complications of esophageal atresia can improve the success of children The quality of life.