Uygun Ibrahim, Zeytun Hikmet, Otcu Selcuk
Department of Paediatric Surgery, Medical Faculty, Dicle University, 21280 Diyarbakir, Turkey.
Afr J Paediatr Surg. 2015 Oct-Dec;12(4):273-9. doi: 10.4103/0189-6725.172572.
Isolated oesophageal atresia without tracheo-oesophageal fistula represents a major challenge for most paediatric surgeons. Here, we present our experience with six neonates with isolated oesophageal atresia who successfully underwent immediate primary anastomosis using multiple Livaditis circular myotomy.
All six neonates were gross type A isolated oesophageal atresia (6%), from among 102 neonates with oesophageal atresia, treated between January 2009 and December 2013. Five neonates were female; one was male. The mean birth weight was 2300 (range 1700-3100) g.
All six neonates successfully underwent immediate primary anastomosis using multiple myotomies (mean 3; range 2-4) within 10 (median 3) days after birth. The gap under traction ranged from 6 to 7 cm. One neonate died of a major cardiac anomaly. Another neonate was lost to follow-up after being well for 3 months. Three anastomotic strictures were treated with balloon dilatation, and four anastomotic leaks were treated conservatively. The mean duration of follow-up was 33 months.
To treat isolated oesophageal atresia, an immediate primary anastomosis can be achieved using multiple myotomies. Although, this approach is associated with high complication rates, as are other similar approaches, these complications can be overcome.
孤立性食管闭锁且无气管食管瘘对大多数小儿外科医生来说是一项重大挑战。在此，我们介绍我们对6例孤立性食管闭锁新生儿的治疗经验，这些患儿成功接受了多次利瓦迪蒂斯环形肌切开术并立即进行了一期吻合。
2009年1月至2013年12月期间治疗的102例食管闭锁新生儿中，所有6例均为A gross型孤立性食管闭锁（6%）。5例为女性，1例为男性。平均出生体重为2300（范围1700 - 3100）g。
所有6例新生儿在出生后10（中位数3）天内成功接受了多次肌切开术（平均3次；范围2 - 4次）并立即进行了一期吻合。牵引下的间隙为6至7 cm。1例新生儿死于严重心脏畸形。另1例新生儿在情况良好3个月后失访。3例吻合口狭窄采用球囊扩张治疗，4例吻合口漏采用保守治疗。平均随访时间为33个月。
对于孤立性食管闭锁的治疗，可通过多次肌切开术实现立即一期吻合。尽管这种方法与其他类似方法一样并发症发生率较高，但这些并发症是可以克服的。
