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目的:总结11年来先天性食管闭锁17例手术治疗的经验,介绍经胸膜外手术技术及其优点。方法:经胸膜外入路法即切开4/5肋间,小心分离肋间肌,先以小蚊式钳小心分开肋骨,再用食指剥离胸膜。注意操作轻柔,仔细剥离胸膜顶及肺门处。胸膜有少许破损可继续完成剥离。术后胸膜外间隙不需引流,食管内亦不留置支架。结果:17例中5例经胸食管吻合仅存活1例,11例胸膜外吻合存活8例(72.7%)。1例Ⅰ型结肠代食管成功。结论:通过17例先天性食管闭锁的治疗,体会到经胸膜外手术后呼吸系统并发症少,及早正确的诊治,熟练的手术技巧,减少食管吻合的张力是提高治愈率的关键。
OBJECTIVE: To summarize the experience of 17 cases of surgical treatment of congenital esophageal atresia over the past 11 years, and to introduce the technique of extrapleural surgery and its advantages. Methods: The method of extrapleural approach that cut 4/5 intercostal space, carefully separated from the intercostal muscles, the first small mosquito forceps to separate ribs, and then use the index finger to peel off the pleura. Note gentle operation, carefully peel the top of the pleura and hilar. A little damage to the pleura can continue to be stripped. Postoperative pleural space without drainage, esophageal nor indwelling stent. Results: Among the 17 cases, only 5 cases survived thoracic esophageal anastomosis and 1 case survived pleural anastomosis in 8 cases (72.7%). A case of type Ⅰ colon on behalf of the esophagus success. Conclusion: Through the treatment of 17 cases of congenital esophageal atresia, we can see that the fewer complications of respiratory system after pleurodesis, the correct diagnosis and treatment as soon as possible, the skill of surgery and the reduction of esophageal anastomosis tension are the keys to improve the cure rate.