Paediatric Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Paediatric Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
BMJ Case Rep. 2021 Jan 28;14(1):e238823. doi: 10.1136/bcr-2020-238823.
Anastomotic leakage (AL) occurs in 15% of cases of primary repair of oesophageal atresia. Urgent surgery is indicated in cases of complete anastomotic separation or severe mediastinitis. Otherwise, conservative management including keeping the patient nil per os (NPO), feeding via transanastomotic tube and prolonged parenteral nutrition, has been widely accepted as it can avoid multiple surgeries in neonates and allow oesophageal continuity to be preserved. However, complications relating to prolonged feeding tube use are common downsides to this approach and the negative impact of prolonged NPO on mastication and swallowing function cannot be ignored.In this case report, a novel approach for the treatment of AL with fibrin glue is reported, following primary repair of oesophageal atresia. It was endoscopically injected into the leakage site to enhance healing and early closure. This procedure was safely performed and achieved early establishment of oral feeding.
食管闭锁术后吻合口漏（AL）的发生率为 15%。完全吻合口分离或严重纵隔炎时需要紧急手术。否则，广泛接受的保守治疗包括让患者禁食（NPO）、经吻合口管喂食和长期肠外营养，因为它可以避免新生儿多次手术，并保持食管连续性。然而，长时间使用喂养管相关的并发症是这种方法的常见缺点，长时间禁食对咀嚼和吞咽功能的负面影响也不容忽视。本病例报告介绍了一种在食管闭锁一期修复术后用纤维蛋白胶治疗 AL 的新方法。将其内镜下注射到漏口部位以促进愈合和早期闭合。该操作安全进行，并早期建立了经口喂养。
