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浙江大学学报（医学版）
浙江大学学报（医学版）  2018, Vol. 47 Issue (3): 266-271    DOI: 10.3785/j.issn.1008-9292.2018.06.08
专题报道     
胸腔镜手术治疗Ⅲ型食管闭锁合并气管食管瘘新生儿的疗效
张玉喜(),莫绪明*(),孙剑,彭卫,戚继荣,武开宏,束亚琴
南京医科大学附属儿童医院心胸外科, 江苏 南京 210008
Application of thoracoscopic surgery in repairing esophageal atresia type Ⅲ with tracheoesophageal fistula in neonates
ZHANG Yuxi(),MO Xuming*(),SUN Jian,PENG Wei,QI Jirong,WU Kaihong,SU Yaqin
Department of Cardiovascular and Thoracic Surgery, the Affiliated Children's Hospital of Nanjing Medical University, Nanjing 210008, China
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摘要：

目的: 比较胸腔镜与开胸手术治疗新生儿Ⅲ型食管闭锁合并气管食管瘘的疗效。方法: 回顾性分析2012年1月至2017年12月南京医科大学附属儿童医院手术治疗的97例Ⅲ型食管闭锁合并气管食管瘘患儿的资料。根据手术方式将所有患儿分为开胸手术组（75例）和胸腔镜手术组（22例），比较两组患儿手术相关指标和术后早期并发症的发生率。结果: 所有患儿均顺利完成手术。胸腔镜手术组有1例（4.5%）患儿食管两盲端距离大于4.0 cm，且远端偏细，中转开胸并行Ⅰ期改良Livaditis食管吻合术。胸腔镜手术组的手术时间较开胸手术组延长[分别为（143±48）min和（120±40）min]，但呼吸机通气时间较开胸手术组缩短[分别为（55±22）h和（65±19）h]，第一次经口喂养时间较开胸手术组提前[分别为（3.2±1.1）d和（3.9±1.3）d，均P < 0.05]；两组红细胞输注例数、住院时间、胸腔引流管置管时间差异均无统计学意义（均P>0.05）。开胸手术组术后肺部并发症发生率高于胸腔镜手术组（分别为20.0%和9.1%，P < 0.01），而其他并发症发生率两组间差异均无统计学意义（均P>0.05）。随访中开胸手术组2例患儿死亡，胸腔镜手术组无死亡。结论: 胸腔镜手术治疗Ⅲ型食管闭锁合并气管食管瘘相对于常规开胸手术具有较明显的优势，值得临床推广应用。
关键词： 食管闭锁/外科学;  气管食管瘘/外科学;  胸腔镜检查/方法;  婴儿, 新生;  治疗结果    
Abstract:

Objective: To compare the efficacy of thoracoscopic surgery versus thoracotomy in repairing esophageal atresia type Ⅲ with tracheoesophageal fistula (EA/TEF) in neonates. Methods: A retrospective analysis was conducted in 97 neonates who underwent EA/TEF repair between January 2012 and December 2017 in the Affiliated Children's Hospital of Nanjing Medical University, including 75 patients receiving thoracotomy and 22 patients receiving thoracoscopic surgery. The perioperative data and the incidence of early postoperative complications were compared between two groups. Results: The operations were completed in all patients. One child (4.5%) in thoracoscopic surgery group was converted to thoracotomy with modified Livaditis procedure due to the long distance of two blind ends (>4 cm) and thinner distal end. The operation time was longer in thoracoscopic surgery group[(143±48) min vs. (120±40) min, P < 0.05], but the postoperative ventilation time was shorter[(55±22) h vs. (65±19) h, P < 0.05] and the first oral feeding was earlier in thoracoscopic surgery group[(3.2±1.1) d vs (3.9±1.3) d, P < 0.05]. No statistical difference was observed in the ratio of red blood cell transfusion, length of hospital stay and drainage tube indwelling time between two groups (all P>0.05). The incidence of lung complications in thoracotomy group was higher than that in thoracoscopic surgery group (20.0% vs. 9.1%, P < 0.01), while there were no significant differences in the incidence of other postoperative complications between two groups. There was no death in thoracoscopic surgery group, while 2 patients died in thoracotomy group. Conclusion: Thoracoscopic repair is a preferred surgical procedure for EA/TEF in neonates.
Key words: Esophageal atresia/surgery    Tracheoesophageal fistula/surgery    Thoracoscopy/methods    Infant, newborn    Treatment outcome
收稿日期: 2018-03-23 出版日期: 2018-09-18
CLC:  R628  
基金资助: 江苏省妇幼健康科研项目(F201611)
通讯作者: 莫绪明     E-mail: fanli0.618@163.com;mohsuming15@sina.com
作者简介: 张玉喜(1983-), 男, 博士研究生, 住院医师, 主要从事小儿心胸外科疾病相关临床研究; E-mail:fanli0.618@163.com; https://orcid.org/0000-0001-8320-0072
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张玉喜
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束亚琴

引用本文:

张玉喜,莫绪明,孙剑,彭卫,戚继荣,武开宏,束亚琴. 胸腔镜手术治疗Ⅲ型食管闭锁合并气管食管瘘新生儿的疗效[J]. 浙江大学学报（医学版）, 2018, 47(3): 266-271.

ZHANG Yuxi,MO Xuming,SUN Jian,PENG Wei,QI Jirong,WU Kaihong,SU Yaqin. Application of thoracoscopic surgery in repairing esophageal atresia type Ⅲ with tracheoesophageal fistula in neonates. J Zhejiang Univ (Med Sci), 2018, 47(3): 266-271.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2018.06.08    或    http://www.zjujournals.com/med/CN/Y2018/V47/I3/266

[${\bar x}$±s或n(%)]
组别 n 体质量(kg) 手术时年龄(d) 男性/女性(n) 孕周(周) 合并肺炎 Gross分型 Spitz分型[5] 合并症
Ⅲa Ⅲb Ⅰ Ⅱ Ⅲ 先天性心脏病* VACTERL综合征 唐氏综合征 其他
“—”无相关数据；*包括动脉导管未闭、室间隔缺损、房间隔缺损、右心室双出口和法洛四联症.
开胸手术组 75 2.3±0.6 3.8±3.8 49/26 37.7±2.1 18(24.0) 35(46.7) 40(53.3) 52(69.3) 13(17.3) 10(13.3) 27(36.0) 4(5.3) 3(4.0) 8(10.7)
胸腔镜手术组 22 2.5±0.7 4.1±4.0 11/11 37.4±2.1 5(22.7) 10(45.5) 12(54.5) 11(50.0) 6(27.3) 5(22.7) 5(22.7) 2(9.1) 1(4.5) 2(9.1)
χ2/t值 — 1.452 0.354 0.146 0.447 0.575 0.558 2.808 0.183 0.412 0.649 0.595
P值 — ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05
表 1  开胸手术组与胸腔镜手术组一般临床资料比较
[${\bar x}$±s或n(%)]
组别 n 手术时间(min) 红细胞输注例数 住院时间(d) 呼吸机通气时间(h) 胸腔引流管置管时间(d) 第一次经口喂养时间(d)
“—”无相关数据.
开胸手术组 75 120±40 6(8.0) 15±3 65±19 6.5±2.1 3.9±1.3
胸腔镜手术组 22 143±48 1(4.5) 12±4 55±22 6.3±2.0 3.2±1.1
χ2/t值 — 2.518 0.499 3.810 2.093 0.397 2.294
P值 — ＜0.05 ＞0.05 ＞0.05 ＜0.05 ＞0.05 ＜0.05
表 2  开胸手术组和胸腔镜手术组术中和术后相关指标比较
[n(%)]
组别 n 肺部并发症* 气管狭窄 吻合口瘘 吻合口狭窄 胃食管反流
“—”无相关数据.*包括肺炎、肺不张等.
开胸手术组 75 15(20.0) 3(4.0) 7(9.3) 32(42.7) 8(10.7)
胸腔镜手术组 22 2(9.1) 1(4.5) 2(9.1) 8(36.4) 1(4.5)
χ2值 — 0.146 0.197 0.668 0.392 0.348
P值 — ＜0.01 ＞0.05 ＞0.05 ＞0.05 ＞0.05
表 3  开胸手术组和胸腔镜手术组术后早期并发症发生率比较
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