摘要目的 探讨胸腔镜下食管闭锁修补术后食管气管瘘复发的可行性、手术经验及疗效.方法 回顾性分析2017年10月至2018年10月间胸腔镜下手术修补食管闭锁术后食管气管瘘复发18例的临床资料.其中,男7例,女11例;术前体重4.3～12.0 kg,平均6.4kg;均于生后诊断为食管闭锁Ⅲ型;开胸完成食管吻合9例,胸腔镜下完成吻合9例.17例首次食管气管瘘复发患儿的复发年龄为10.4～79.6周,平均26.2周;1例患儿第3次食管气管瘘复发年龄2岁8个月.手术采用“三孔法”,在胸腔镜下寻找气管与食管间隙并分离瘘管,缝扎食管气管瘘,剪断瘘管并分别缝补食管及气管,游离椎前筋膜间置于食管及气管吻合口之间预防术后再次复发,术毕留置胸腔引流管.结果 手术时间(3.3±1.4)h,时间范围在1.5～7.5 h.2例出现术后食管漏,其中1例因严重营养不良合并重症感染死亡,1例再次食管气管瘘复发.另16例术后住院时间(15.6±5.6)d,时间范围在11～23 d.术后随访1个月至1年,16例患儿中14例可以正常经口喂养,1例因右侧声带运动障碍仍有进食后呛咳表现,1例因右眼先天性白内障术后感染需长期俯卧位不能正常进食.本组除1例死亡外,17例随访期体重6.0～16.5 kg,平均9.4kg.结论 经胸腔镜手术修补先天性食管闭锁术后复发性食管气管瘘安全、有效,但需要术者具备熟练的胸腔镜手术操作技术及经验丰富的护理团队配合.

abstractsObjective To explore the feasibility,surgical experience and efficacy of thoracoscopic repair of recurrent tracheoesophageal fistula (rTEF) after operation for esophageal atresia.Methods From October 2017 to October 2018,a total of 18 rTEF children underwent 3-Trocar thoracoscopy and their clinical data were retrospectively analyzed.All of them were diagnosed postnatally as esophageal atresia (type Ⅲ).There were 7 boys and 11 girls with a preoperative average body weight of 6.4(4.3-12.0) kg.Thoracic esophageal anastomosis (n =9) and thoracoscopic anastomosis (n=9) were performed.Seventeen rTEF children were initially diagnosed at an average age of 26.2 (10.4-79.6) weeks.After separating trachea-esophageal space and fistula,esophagus and trachea were sutured separately.Tracheal fistula was wrapped with a pleural patch and a thoracic drainage tube finally inserted.Results The average operative duration was (3.3 ± 1.4) (1.5-7.5)hours.For two cases of postoperative esophageal leakage,one died of severe infection and another had a recurrence of tracheal esophageal fistula.The average hospitalization length was (15.6 ± 5.6)(11-23) days.After a follow-up period of 1 month to 1 year,14/16 children resumed oral intake while another 2 cases required nasogastric feeding due to right vocal cord dysfunction and eye infection after right glaucoma operation respectively.Except for one death,the average body weight was 9.4(6.0-16.5) kg during follow ups.Conclusions With skilled thoracoscopic techniques and an experienced nursing team,thoracoscopy is both safe and efficacious for repairing rTEF.