[胸腔镜手术在新生儿Ⅲ型食管闭锁合并气管食管瘘修复中的应用]
[Application of thoracoscopic surgery in repairing esophageal atresia type Ⅲ with tracheoesophageal fistula in neonates].
作者信息
Zhang Yuxi, Mo Xuming, Sun Jian, Peng Wei, Qi Jirong, Wu Kaihong, Su Yaqin
机构信息
Department of Cardiovascular and Thoracic Surgery, the Affiliated Children's Hospital of Nanjing Medical University, Nanjing 210008, China.
出版信息
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2018 May 25;47(3):266-271. doi: 10.3785/j.issn.1008-9292.2018.06.08.
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, <0.05], but the postoperative ventilation time was shorter[(55±22) h vs. (65±19) h, <0.05] and the first oral feeding was earlier in thoracoscopic surgery group[(3.2±1.1) d vs (3.9±1.3) d, <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 >0.05). The incidence of lung complications in thoracotomy group was higher than that in thoracoscopic surgery group (20.0% vs. 9.1%, <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.
CONCLUSIONS
Thoracoscopic repair is a preferred surgical procedure for EA/TEF in neonates.
目的
比较胸腔镜手术与开胸手术修复新生儿Ⅲ型食管闭锁合并食管气管瘘（EA/TEF）的疗效。
方法
对2012年1月至2017年12月在南京医科大学附属儿童医院接受EA/TEF修复术的97例新生儿进行回顾性分析，其中75例行开胸手术，22例行胸腔镜手术。比较两组围手术期数据及术后早期并发症发生率。
结果
所有患者手术均顺利完成。胸腔镜手术组有1例患儿（4.5%）因两端盲端距离长（>4 cm）且远端较细，中转开胸行改良Livaditis手术。胸腔镜手术组手术时间较长[（143±48）分钟 vs.（120±40）分钟，<0.05]，但术后通气时间较短[（55±22）小时 vs.（65±19）小时，<0.05]，首次经口喂养时间较早[（3.2±1.1）天 vs.（3.9±1.3）天，<0.05]。两组红细胞输血比例、住院时间及引流管留置时间比较，差异均无统计学意义（均>0.05）。开胸手术组肺部并发症发生率高于胸腔镜手术组（20.0% vs. 9.1%，<0.01），而两组其他术后并发症发生率比较差异无统计学意义。胸腔镜手术组无死亡病例，开胸手术组有2例死亡。
结论
胸腔镜修复术是新生儿EA/TEF的首选手术方式。
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