Cui Xu, He Yuanbin, Chen Liu, Lin Yu, Wang Yunjin, Zhang Jianqin, Zhou Chaoming
Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital, Fuzhou, P. R. China.
J Laparoendosc Adv Surg Tech A. 2020 Apr;30(4):448-452. doi: 10.1089/lap.2019.0611. Epub 2020 Feb 11.
The aim of this study was to investigate the clinical effectiveness of azygos vein preservation when using a thoracoscope in the operation for type III esophageal atresia for children. We retrospectively analyzed the clinical data of 34 patients (group B) who underwent the thoracoscopic operation of type III esophageal atresia with azygos vein preservation from January 2017 to April 2018. The clinical data of 36 patients (group A) who underwent the thoracoscopic operation of type III esophageal atresia with azygos vein mutilation from April 2015 to December 2016 were selected as a control group. All patients were successfully operated on. There was no significant difference in the operation time, amount of bleeding, mechanical ventilation time, and intensive care time between the azygos vein mutilation group and azygos vein preservation group. Compared with the operation severing the azygos vein, preservation of azygos vein has obvious advantages in postoperative hospitalization time, the incidence of anastomotic leakage ( < .05). The follow-up results for 1 year after the operation showed that the incidence of anastomotic stricture with preservation of azygos vein was significantly lower than that with azygos vein transection ( < .05). The thoracoscopic operation of type III esophageal atresia with azygos vein preservation can not only improve the edema of esophageal tissue around the esophagus, but also reduce the occurrence of esophageal anastomotic leakage and accelerate the postoperative recovery of children, and it has the same safety as the operation with azygos vein mutilation.
本研究旨在探讨小儿Ⅲ型食管闭锁手术中使用胸腔镜时保留奇静脉的临床效果。我们回顾性分析了2017年1月至2018年4月期间34例行Ⅲ型食管闭锁胸腔镜手术并保留奇静脉的患儿（B组）的临床资料。选取2015年4月至2016年12月期间36例行Ⅲ型食管闭锁胸腔镜手术且奇静脉被切断的患儿（A组）的临床资料作为对照组。所有患儿手术均成功。奇静脉切断组与奇静脉保留组在手术时间、出血量、机械通气时间及重症监护时间方面差异无统计学意义。与切断奇静脉的手术相比，保留奇静脉在术后住院时间、吻合口漏发生率方面具有明显优势（P<0.05）。术后1年随访结果显示，保留奇静脉组吻合口狭窄发生率明显低于奇静脉切断组（P<0.05）。Ⅲ型食管闭锁胸腔镜手术保留奇静脉不仅能改善食管周围组织水肿，还能降低食管吻合口漏的发生率，加速患儿术后恢复，且与切断奇静脉手术安全性相当。
