胸腔镜下一期修复术对低体重儿的食管闭锁合并气管食管瘘有效。
Thoracoscopic primary repair is useful for esophageal atresia with tracheoesophageal fistula in neonates with low body weight.
机构信息
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
出版信息
Pediatr Surg Int. 2024 Jun 3;40(1):149. doi: 10.1007/s00383-024-05724-x.
PURPOSE
The surgical indication of thoracoscopic primary repair for esophageal atresia with tracheoesophageal fistula is under debate. The current study aimed to investigate the outcome of thoracoscopic primary repair for esophageal atresia with tracheoesophageal fistula in patients weighing < 2000 g and those who underwent emergency surgery at the age of 0 day.
METHODS
The surgical outcomes were compared between patients weighing < 2000 g and those weighing > 2000 g at surgery and between patients who underwent surgery at the age of 0 day and those who underwent surgery at age ≥ 1 day.
RESULTS
In total, 43 patients underwent thoracoscopic primary repair for esophageal atresia with tracheoesophageal fistula. The surgical outcomes according to body weight were similar. Patients who underwent surgery at the age of 0 day were more likely to develop anastomotic leakage than those who underwent surgery at the age of ≥ 1 day (2 vs. 0 case, p = 0.02). Anastomotic leakage was treated with conservative therapy.
CONCLUSION
Thoracoscopic primary repair is safe and useful for esophageal atresia with tracheoesophageal fistula even in newborns weighing < 2000 g. However, emergency surgery at the age of 0 day should be cautiously performed due to the risk of anastomotic leakage.
目的
胸腔镜下食管闭锁合并气管食管瘘一期修复的手术适应证仍存在争议。本研究旨在探讨对于体质量<2000 g 的患儿和生后第 0 天行急诊手术的患儿，行胸腔镜下食管闭锁合并气管食管瘘一期修复的治疗效果。
方法
比较体质量<2000 g 和>2000 g 的患儿以及生后第 0 天和生后第 1 天及以后行手术的患儿之间的手术结果。
结果
共 43 例行胸腔镜下食管闭锁合并气管食管瘘一期修复术的患儿。根据体质量的手术结果相似。生后第 0 天行手术的患儿吻合口漏的发生率高于生后第 1 天及以后行手术的患儿（2 例比 0 例，p=0.02）。吻合口漏通过保守治疗治愈。
结论
即使对于体质量<2000 g 的新生儿，胸腔镜下食管闭锁合并气管食管瘘一期修复术也是安全有效的。然而，由于吻合口漏的风险，生后第 0 天行急诊手术应谨慎进行。
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