【摘要】 目的探讨Ⅲ型先天性食管闭锁手术后吻合口漏的原因以及临床处理策略。方法回顾性分析2012年1月至2020年9月徐州市儿童医院收治的116例Ⅲ型先天性食管闭锁患者临床资料,根据手术后是否存在吻合口漏分为两组,观察组为有吻合口漏病例,共25例;对照组为无吻合口漏病例,共91例。比较两组患者在性别、胎龄、入院体重、手术年龄、Ⅲ型食管闭锁类型(ⅢA或ⅢB)、术前前白蛋白水平、手术时间、合并畸形、合并畸形是否同时手术、是否行食管延长术(Livaditis手术)、呼吸机使用时间、住院时间以及术后吻合口狭窄、食管气管瘘复发等方面的差异,探讨导致吻合口漏的相关影响因素。结果两组在性别、手术年龄、手术时间、术后吻合口狭窄方面比较,差异无统计学意义(P均>0.05)。观察组胎龄(37.5±3.00)周,对照组(38.7±2.0)周,差异有统计学意义(P=0.016)。观察组入院体重(2.49±0.66)kg,对照组入院(2.75±0.51)kg,差异有统计学意义(P=0.040)。观察组中ⅢA型食管闭锁、合并畸形、合并畸形需同时手术、行Livaditis手术以及食管气管瘘复发占比均较对照组高,差异均有统计学意义(P均<0.05)。观察组手术前前白蛋白水平正常者较对照组少,差异有统计学意义(P=0.035)。观察组住院时间为(36.9±21.9)d,对照组为(19.6±6.0)d,差异有统计学意义(P<0.05)。观察组呼吸机使用时间为(6.96±4.73)d,对照组为(3.80±2.74)d,差异有统计学意义(P<0.05)。结论Ⅲ型先天性食管闭锁患者胎龄、入院体重、术前前白蛋白水平、食管闭锁类型、是否行livaditis手术以及合并畸形情况与术后吻合口漏密切相关。大多数吻合口漏经保守治疗可愈合,少数需再次手术。更多还原

【Abstract】 Objective To investigate the causes and treatment strategies of anastomotic leakage after operation of type Ⅲ congenital esophageal atresia. Methods The clinical data of 116 cases with type Ⅲ congenital esophageal atresia admitted to Children’s Hospital Affiliated to Medical University from January 2012 to September 2020 were retrospectively analyzed.All cases were divided into two groups according to the presence or absence of anastomotic leakage after operation of esophageal atresia.25 cases were included in the observation group with anastomotic leakage, and 91 cases were included in the control group.Gender, gestational age, weight at admission, age at the time of operation, operation time, combined malformation, hospital stay, type Ⅲ esophageal atresia(Ⅲ a or Ⅲ b),preoperative albumin level, time of ventilator use, presence of esophageal lengthening surgery(Livaditis operation),postoperative complications of patients, occurrence of anastomotic stenosis and recurrence of esophagotracheal fistula were compared between the two groups, and the influencing factors of anastomotic leakage were analyzed. Results There were no significant differences between the two groups in gender, operation age, operation time and postoperative anastomotic stenosis(P>0.05).The gestational age was(37.5±3.00) weeks in the observation group and(38.7±2.0) weeks in the control group, the difference was statistically significant(P=0.016),and the body weight at admission was(2.49±0.66) kg in the observation group and(2.75±0.51) kg in the control group, the difference was statistically significant(P=0.040); In the observation group, the patients with type ⅢA esophageal atresia, malformations, malformations requiring simultaneous operation, Livaditis operation and recurrence of esophagotracheal fistula were significantly more than those in the control group(P<0.05).Patients with normal pre-operation albumin level in the observation group was significantly less than those in the control group(P=0.035); The hospitalization time was(36.9±21.9) days in the observation group and(19.6±6.0) days in the control group, the difference was statistically significant(P<0.001),and the time of ventilator use was(6.96±4.73) days in the observation group and(3.80±2.74) days in the control group, the difference was statistically significant(P<0.001). Conclusion The gestational age, weight at admission, preoperative albumin level, type of esophageal atresia, the presence of Livaditis operation and associated malformations are closely related to postoperative anastomotic leakage for children with type Ⅲ congenital esophageal atresia.Most of the children with anastomotic leakage heal after conservative treatment, only a few cases need reoperations.更多还原