先天性食管闭锁术后患儿短期预后的分析
投稿时间:2015-12-16  修订日期:2015-12-29  点此下载全文
引用本文:梁忠杰,陈北涛,胡型锑,陈尚勤.先天性食管闭锁术后患儿短期预后的分析[J].医学研究杂志,2016,45(6):127-129
DOI: 10.11969/j.issn.1673-548X.2016.06.032
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作者单位E-mail
梁忠杰 325000 温州医科大学附属第二医院、育英儿童医院新生儿科  
陈北涛 325000 温州医科大学附属第二医院、育英儿童医院新生儿科  
胡型锑 325000 温州医科大学附属第二医院、育英儿童医院新生儿科  
陈尚勤 325000 温州医科大学附属第二医院、育英儿童医院心胸外科 csq5725@126.com 
中文摘要:目的 通过回顾性分析先天性食管闭锁接受手术治疗的患儿临床资料,了解影响其短期预后的因素,以改善食管闭锁手术患儿的预后。方法 收集并分析笔者医院2008年1月~2014年12月接受过手术治疗的46例先天性食管闭锁患儿的临床资料。结果 46例患儿中3例术中因食管闭锁两盲端距离过大放弃。43例患儿完成手术治疗,其中转院2例。26例治愈出院的患儿,出生体重2976.0±554.6g;15例死亡患儿,出生体重2337.3±498.1g;这41例患儿,足月儿有31例,死亡7例,早产儿10例,死亡8例。较大的出生体重(P=0.008)和较长的胎龄(P=0.002)有助于患儿术后生存;发生术后吻合口瘘14例,发生率为34.15%,其中死亡10例,治愈4例,吻合口瘘患儿病死率高于无该并发症患儿(P=0.001);Ⅲa型20例,发生吻合口瘘6例,Ⅲb型21例,吻合口瘘8例,吻合口瘘发生与疾病分型无关(P>0.05)。结论 小胎龄、低体重以及术后吻合口瘘是先天性食管闭锁术后患儿短期预后不良的主要因素,加强护理,减少吻合口瘘的发生将可能助于改善患儿预后。近端食管肌层环形切开延伸术,可以减少吻合口张力,减少吻合口瘘的发生。
中文关键词:食管闭锁  手术  预后
 
Analysis on Factors of Prognosis in Children with Esophageal Atresia after Surgery
Abstract:Objective To investigate the prognostic factors of survival rate after repair of esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) through reviewing the clinical data of EA children who received surgical treatment retrospectively. Methods The clinical data of the 46 children underwent TEF/EA repair operation between January 2008 and December 2014 in our hospital were retrospectively investigated. Results Three children abandon the treatment during the surgery because of the long distance of the two dead end of esophageal atresia. A total of 43 children received surgical treatment. Two of them transferred to other hospital, 26 children survived with birth weight 2976.0±554.6g, and 15 children died with birth weight 2337.3±498.1g. These 41 children included 31 term infants(7 died) and 10 preterm(8 died). Postoperative survival rate positively correlated with the birth weight(P=0.008) and gestational age(P=0.002).Fourteen children developed postoperative anastomotic leakage, and the anastomotic leakage rate was 34.15%.Ten children died and only 4 survived. The survival rate of children with anastomotic leakage was lower than those not. Twenty children were type Ⅲa, and 6 of them developed postoperative anastomotic leakage and 22 children were type Ⅲb, 8 of them developed anastomotic leakage. The anastomotic leakage and not correlate with the type of disease(P>0.05). Conclusion Small gestational age, low birth weight and postoperative anastomotic leakage are the prognostic factors of survival rate after repair of EA and/or TEF.Intensive nursing care and reducing the incidence of anastomotic leakage may help to improve the outcome. Proximal esophageal muscle extending annular incision surgery could lessen anastomotic tension and reduce the incidence of anastomotic leakage.
keywords:Esophageal atresia  Surgery  Prognosis
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