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目的 总结 32例先天性食管闭锁手术治疗经验。方法 手术均采用食管上盲端前壁肌层U形翻转 ,即经胸膜外入路充分游离食管上端及瘘管 ,近气管侧缝扎切断瘘管。用剪刀将远端食管前壁纵行剪开 5mm ,吻合前距吻合口上方 1 0mm处行食管上下两端浆肌层缝合 3针 ,然后距吻合口上方1 5～ 2 0mm处将食管前壁肌层切开 ,从切开处向吻合口方向从两侧纵行切开肌层至吻合口约 5mm ,轻轻分离前壁肌瓣 ,形成U形向下翻转 ,缝合在食管远端浆肌层上。结果 32例中 1 7例采用此方法未发生吻合口瘘 ,1例吻合口狭窄。 2例成功行一期胃代食管术。结论 食管上盲端前壁肌瓣U形翻转能有效预防吻合口瘘及狭窄。I、II型食管闭锁采用一期胃代食管术 ,可避免二次手术。
Objective To summarize 32 cases of congenital esophageal atresia surgery experience. Methods The operation was performed on the esophageal anterior wall of the anterior urethral U-shaped flip, that is, the full free esophageal extraperitoneal approach fistula and fistula, near the tracheostomy fistula. Use scissors to cut the anterior longitudinal wall of the distal esophageal 5mm, before anastomosis 10mm above the esophagus from the top and bottom of the esophagus stitching 3-pin, and then from the top of the anastomosis 15 ~ 20mm esophageal anterior wall Myometrial incision, from the incision to the anastomosis direction from both sides of the longitudinal incision muscle layer to the anastomosis of about 5mm, gently separating the anterior wall muscle flap, the formation of U-shaped flip down, suture distal esophageal pulp Layers. Results In 32 cases, 17 cases did not have anastomotic fistula by this method and 1 case had anastomotic stenosis. Two cases of successful gastric esophageal surgery. Conclusion U-turn of the anterior esophageal mucosa on the anterior esophagus can effectively prevent anastomotic fistula and stenosis. I, II esophageal atresia using a stomach esophageal surgery to avoid the second surgery.