食道閉鎖手術治療之六年經驗

Surgical Treatment of Esophageal Atresia-6 Years of Experience

趙德馨(De-Hsin Chao) ； 陳厚全(Hou-Chuan Chen) ； 彭海祁(Hai-Chyi Peng) ； 吳介智(Jieh-Jyh Wu)

《The Kaohsiung Journal of Medical Sciences》 6卷6期 (1990/06) Pp. 283-288

https://doi.org/10.6452/KJMS.199006.0283

摘要

食道閉鎖症是一種先天異常疾病，我們統計台中榮嚴總醫院從1983年5月到1989年12月共治療14例病例，7例男嬰及7例女嬰。依Gross之分類，其中有2例為Type A，只有食道閉鎖，沒有食道氣管瘻管（1）。12例為Type C，合併有遠端食道氣管瘻管。合併其他先天性異常者有3例，分別是1例開放性動脈導管，1例染色體異常（Trisomy 18），及1例多指症。按Waterston等人（2）區分，出生體重大於2500公克，沒有合併他種先天異常或吸入性肺炎之Group A有7例，體重介於1800公克到2500公克之間或2500公克以上但有輕吸入性肺炎之Group B有5例，體重小於1800公克或合併其他嚴重之吸入性肺炎或有致命性先天異常之Group C有2例。手術方式之選擇以食道兩盲端距離為參考，兩例Type A之病例因盲端距離都超過兩公分，需以分期手術治療。有1例Type C之病人因盲端距離大於兩公分，在其他醫院施行瘻管結紮，頸部食道造口及胃造瘻術後，轉來本院，以右側結腸做食道重建手術。有10例Type C之病例因盲端距離小於兩公分都經由肋膜外行食道吻合手術治療；另1例Type C病例雖然盲端距離大於兩公分，亦採用直接吻合治癒。有3例手術後併發吻點處滲漏，其中1例癒合後造成狹窄。有3例分別因為肺出血、敗血症，與肺炎而亡。病人之存活率於Group A為100%，Group B為80%，Group C的兩個病例均死亡。

並列摘要

Surgical treatment of fourteen infants with esophageal atresia over the past six years was reviewed retrospectively. Two patients had esophageal atresia without tracheoesophageal fistula (Gross Type A), the other 12 patients had distal tracheoesophageal fistula (gross Type C). Associated anomalies were found in three patients: one had a patent ductus arterious, another had trisomy 18, and the third had polydactylia. According to Wateston’s risk group classification, there were 7 cases in Group A, 5 in Group B and 2 in Group C. The choice of operative method mainly depended on the distance between the two esophageal ends. Two patients with Type A atresia were treated by a staged operation because the distance between the two esophageal blind ends far exceedes 2 cm. A Type C patient with a “gap” longer than 2 cm who first had his esophagostomy, gastrostomy and ligation of the tracheoesophageal fistula at another hospital was transferred to us to get an esophageal reconstruction using a right-side ileocolon. Another ten Type C patients with a “gap” of less than 2 cm were operated on by extrapleural end-to-end esophago-esophagostomy after their tracheo-esophageal fistula was closed. The remaining Type C patient with a longer gap of about 3 cm was treated by primary anastomosis following mobilization of the upper pouch as well as limited mobilization of the lower esophageal segment. Anastomotic leakage was found in three patients. One patient developed subsequent stricture when the leakage was healed. The causes of mortality in three patients were pulmonary hemorrhage, sepsis and pneumonia respectively. The survival rate in our series was 100% in Group A, 80% in Group B and none in Group C.

並列關鍵字

esophageal atresia ； trachea-esophageal fistula