摘要目的 探讨全胃转移替代食管法治疗长距离(＞3 cm)食管闭锁的疗效.方法 对2005年3月至2010年10月收治的长距离(＞3 cm)食管闭锁患儿7例进行回顾性分析,其中男5例,女2例.年龄2～96 h(平均36 h).出身时体重1800～3 500 g.入院后食管造影确诊为食管闭锁.其中Ⅰ型2例,Ⅲa型5例.所有患儿均采用全胃转移替代食管法治疗.结果 所有患儿均顺利完成手术,手术时间150～200 min,平均180 min.7例均行幽门成形术,术后予以呼吸机支持及静脉营养等治疗.其中1例死亡；1例家长放弃治疗;1例并发吻合口瘘经充分引流、静脉营养等治疗,瘘口自行愈合.随访1～5年:5例中2例吻合口狭窄行食管扩张治疗；所有患儿经造影检查均存在胃食管反流,3例患儿易患呼吸道感染；4例患儿体重、身高与正常同龄儿无差别；1例患儿存在呼吸受压症状,体重、身高较正常同龄儿低5％.结论 全胃转移替代食管法治疗长距离食管闭锁可以提高患儿的存活率,降低吻合口瘘及吻合口狭窄的发生率,术后经口喂养良好,可以满足生长发育需要.不足之处是术后存在胃食管反流,远期有形成Barret's食管可能.

abstractsObjective To explore the application and efficacy of total gastric transposition in long gap of esophageal atresia (＞3cm) in children.Methods From March 2005 to October 2010,7 cases of patients with long gap esophageal atresia underwent total gastric transposition in our centre,which included 5 males and 2 females with average 36 hours old (ranging from 2 to 96 hours).Their birth weight ranged from 1800 to 3 500 grams.The diagnosis was made based on the chest-abdominal radiograph,they were 2 cases of type Ⅰ and 5 cases of type Ⅲa.Results All procedures were completed and average operating time was 180 minutes (ranging from 150 to 200 minutes).1case died and 1case refused further treatment after operation,1case underwent drainage and nutrition supporting due to postoperative anastomotic leak,and healed which was confirmed by radiograph investigation.The follow-up time ranged from 1to 5 years,in 5 patients dilating procedures were done in 2 cases due to anastomotic stricture and GERD could be seen in all patients.4 cases had a normal height and weight,1case complaining dyspnoea had a lower weight and height.Conclusions Total gastric transposition is effective approach for long gap of esophageal atresia,some advantages can been presented involving improvement of survival for patients after treatment and reduced incidence of anastomotic stricture.Meanwhile,the occurring of GERD and Baeert's esophagus still catch the attention by surgeons.