目的:探讨先天性食管闭锁手术治疗的要点及提高其治愈率的方法。方法:2007年5月~2012年5月该院共收治食管闭锁患儿22例,术前均经食管造影确诊。20例Ⅲ型,其中Ⅲa 5例,Ⅲb 15例,经胸膜外入路Ⅰ期食管气管瘘结扎,食管端端吻合术。2例Ⅳ型患儿经颈部入路,Ⅰ期食管气管瘘结扎,食管端端吻合术。术后1周行食管造影确定有无吻合口瘘,存在吻合口瘘者行鼻饲、静脉营养支持。结果:22例患儿中治愈19例(86.36%),放弃治疗1例(4.54%),死亡2例(9.09%),术后带管造影19例,吻合口瘘3例(3/19例,15.79%),均经静脉营养、鼻饲治愈。随诊19例,随访时间1~3年,2例有吻合口狭窄(2/19例,10.53%),均为发生吻合口瘘患儿,经气囊扩张治愈。结论:早期诊治,重视围手术期呼吸管理及营养支持,选择恰当术式,术中精细操作,减少吻合口漏的发生,仍然是目前提高先天性食管闭锁治愈率的关键。 Objective: To explore the main points of surgical treatment of congenital esophageal atresia and methods to improve the cure rate. Methods: From May 2007 to May 2012, 22 children with esophageal atresia were admitted to the hospital. All patients were confirmed by esophagectomy before operation. There were 20 cases of type Ⅲ, including 5 cases of Ⅲa and 15 cases of Ⅲb. The patients underwent extraperitoneal esophageal fistula ligation and endoscopic esophageal anastomosis. Two cases of type IV children by the neck approach, Ⅰ esophageal fistula ligation, esophageal anastomosis. One week after operation, esophageal angiography was performed to confirm the presence or absence of anastomotic fistula, and anastomotic leakage was performed with nasal feeding and intravenous nutrition support. Results: Among the 22 cases, 19 cases were cured (86.36%), 1 case (4.54%) was abandoned and 2 cases died (9.09%). There were 19 cases underwent angiography and 3 cases of anastomotic fistula (3/19 cases , 15.79%), are intravenous nutrition, nasal feeding cure. Follow-up in 19 cases, follow-up time of 1 to 3 years, 2 cases of anastomotic stenosis (2/19 cases, 10.53%), were occurred in children with anastomotic leakage, the balloon dilated cure. Conclusion: Early diagnosis and treatment, attention to perioperative respiratory management and nutritional support, select the appropriate surgical procedures, fine operation, reduce the occurrence of anastomotic leakage is still the key to improve the cure rate of congenital esophageal atresia.