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目的探讨先天性食管闭锁(CEA)术后近期并发症防治。方法 2002年1月至2011年1月收治的Ⅲ型食管闭锁患儿30例,7例经胸腔入路、23例行经胸膜外入路行瘘管切断食管端端吻合术,术后予抗感染、SIMV(同步间歇指令通气)或HFO(高频振荡通气)呼吸支持、全静脉营养及部分静脉营养等治疗,其中6例食管吻合口瘘采取留置引流管,加强呼吸管理、营养支持及纠正水电解质紊乱等各种综合治疗。结果治愈27例(90.0%),放弃治疗后死亡3例(10.0%);术后予抗感染(13.5+2.8)d,SIMV(3.03+1.58)d,全静脉营养及部分静脉营养(11.97+6.69)d;术后并发吻合口瘘6例,其中经胸腔入路者吻合口瘘发生率28.6%,死亡率14.3%;经胸膜外入路吻合口瘘发生率17.4%,死亡率8.7%。结论合理的呼吸机应用、加强感染及静脉营养等综合治疗对提高先天性食管闭锁生存率起关键作用,食管吻合口瘘是影响术后近期预后的最重要因素,采取经胸膜外入路可减少吻合口瘘的发生率及死亡率。
Objective To investigate the prevention and treatment of recent complications after congenital esophageal atresia (CEA). Methods Thirty patients with type Ⅲ esophageal atresia admitted from January 2002 to January 2011 were enrolled in this study. Seven patients underwent thoracic approach and 23 patients received esophageal end-to-end anastomosis through the extraperitoneal approach through fistula. , SIMV (synchronized intermittent mandatory ventilation) or HFO (high-frequency oscillatory ventilation) respiratory support, total parenteral nutrition and partial parenteral nutrition treatment. Among them, 6 cases of esophageal anastomotic fistula were placed indwelling drainage tube to strengthen the respiratory management, nutritional support and water correction Electrolyte disorders and other comprehensive treatment. RESULTS: Twenty-seven patients (90.0%) were cured and 3 patients (10.0%) were given up their treatment after treatment. The patients were given anti-infective (13.5 ± 2.8) d, SIMV (3.03 ± 1.58) d, total parenteral nutrition and partial parenteral nutrition 6.69) d. There were 6 cases of anastomotic fistula after operation. The incidence rate of anastomotic leakage was 28.6% and the mortality rate was 14.3%. The incidence of anastomotic fistula was 17.4% and the mortality rate was 8.7%. Conclusions Rational ventilator application, intensive infection and intravenous nutrition are the key factors in improving the survival rate of congenital esophageal atresia. Esophageal anastomotic fistula is the most important factor affecting the short-term postoperative prognosis, and the extrapleural approach can reduce Anastomotic fistula incidence and mortality.