【摘要】 目的探讨胸腔镜治疗Ⅲ型食管闭锁术中Hem-o-lok夹在处理气管食管瘘中的应用价值。方法回顾性分析我科2014年10月~2015年5月采用胸腔镜治疗Ⅲ型食管闭锁患儿11例资料,出生体重1800~3100 g,平均2708 g。出生至手术时间2~9 d,平均5.1 d。Ⅲa型4例(其中1例两盲端距离达4 cm),Ⅲb型7例。合并先天性心脏病4例,肛门闭锁1例,多趾畸形1例。在胸腔镜下用5 mm Hem-o-lok夹夹闭气管食管瘘,行食管端端吻合。结果气管食管瘘夹闭均顺利。胸腔镜手术时间120~190 min,平均158 min,术中出血量<5 ml。术后5 d行食管造影,3例吻合口漏,保守治疗1、1、4周,均痊愈。术后随访4~11个月,平均7个月,吻合口狭窄2例,分别行球囊扩张1、3次。无气管食管瘘复发。结论在胸腔镜治疗Ⅲ型食管闭锁手术中,利用Hem-o-lok夹夹闭气管食管瘘,手术更加精准、方便,易于操作,治疗效果满意。更多还原

【Abstract】 Objective To investigate the application of Hem-o-lok clips in thoracoscopic treatment of type Ⅲ esophageal atresia. Methods A retrospective analysis was made on 11 children with type Ⅲ esophageal atresia treated by thoracoscopic surgery from October 2014 to May 2015. The birth weight was 1800- 3100 g,with an average of 2708 g. The time from birth to operation was2- 9 days,with an average of 5. 1 days. There were 4 cases of type Ⅲa atresia,including 1 case with a 4-cm gap between esophageal blind ends,and 7 cases of type Ⅲb. Co-morbidities included congenital heart disease in 4 cases,anal atresia in 1 case,and multiple toe deformity in 1 case. Tracheoesophageal fistula was occluded with 5-mm Hem-o-lok clips under thoracoscopy and an end-to-end esophageal anastomosis was performed. Results All the surgeries were completed successfully. The operation time was 120- 190minutes( average,158 minutes) and the amount of bleeding was less than 5 ml. On the fifth day after operation esophageal radiography showed 3 cases of anastomotic leakage,all of which were recovered after 1,1,and 4 weeks of conservative treatment. The follow-up period was 4- 11 months( average,7 months). Anastomotic stenosis was found in 2 cases and was given balloon dilatation for 1 and 3times,respectively. No recurrence of tracheoesophageal fistula occurred. Conclusion The application of Hem-o-lok clips of tracheoesophageal fistula in thoracoscopic treatment of type Ⅲ esophageal atresia is accurate,convenient,and easy to operate,with satisfactory surgical effects.更多还原