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高频通气下胸腔镜治疗食管闭锁的探索

Exploration of the thoracoscopic treatment of esophageal atresia under high-frequency ventilation.

作者信息

Zheng Chao, Lin Yu, He Yuanbin, Shen Yong, Fan Jiansen, Fang Yifan

机构信息

Department of Pediatric Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), Fuzhou, China.

College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.

出版信息

Front Pediatr. 2022 Dec 22;10:1066492. doi: 10.3389/fped.2022.1066492. eCollection 2022.

Abstract

OBJECTIVE

Explore the feasibility and safety of thoracoscopy in the treatment of esophageal atresia under high-frequency oscillatory ventilation (HFOV) mode.

METHODS

This was a single-center retrospective analysis. A total of 24 children were divided into the HFOV and the No-HFOV group. The demographic information, surgical results and relevant experience were analyzed.

RESULTS

All patients in the HFOV group underwent thoracoscopic esophageal atreplasty with a mean operation duration of 165.8 ± 33.9 min. Two patients had postoperative anastomotic leakage, which was cured after conservative treatment. One child had a recurrent tracheoesophageal fistula, which was closed after endoscopic cauterization. The mean postoperative mechanical ventilation time was 8.83 ± 8.02 days. There was no return of anastomotic leakage or r-TEF after oral feeding. Furthermore, there was no significant difference between the NO-HFOV and the HFOV groups except for the operation time where the HFOV group was shorter than that of the NO-HFOV group.

CONCLUSION

Thoracoscopic esophageal atresia anastomosis under HFOV ventilation is feasible for patients with severe pulmonary infection, heart malformation, such as patent ductus arteriosus, ventricular septal defect, and poor anesthesia tolerance, but the long-term prognosis still needs further study in a large sample size.

摘要

目的

探讨在高频振荡通气(HFOV)模式下胸腔镜治疗食管闭锁的可行性及安全性。

方法

这是一项单中心回顾性分析。共24例患儿被分为HFOV组和非HFOV组。分析了人口统计学信息、手术结果及相关经验。

结果

HFOV组所有患者均接受了胸腔镜食管闭锁修复术,平均手术时长为165.8±33.9分钟。2例患者术后出现吻合口漏,经保守治疗后治愈。1例患儿出现复发性气管食管瘘,经内镜烧灼后闭合。术后平均机械通气时间为8.83±8.02天。经口喂养后未出现吻合口漏或复发性气管食管瘘复发。此外,除手术时间外,非HFOV组与HFOV组之间无显著差异,HFOV组的手术时间短于非HFOV组。

结论

对于患有严重肺部感染、心脏畸形(如动脉导管未闭、室间隔缺损)及麻醉耐受性差的患者,在HFOV通气下进行胸腔镜食管闭锁吻合术是可行的,但长期预后仍需大样本进一步研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64b3/10107367/1dee32e9fd35/fped-10-1066492-g001.jpg

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