Experience in the treatment of congenital esophageal atresia with type Ⅲ a staged surgery
Objective To summarize the institutional experiences of esophageal reconstruction surgery for type Ⅲa congenital esophageal atresia(CEA).Methods From July 2020 to February 2022,retrospective analysis was performed for the relevant clinical data of 3 boys with type Ⅲa CEA undergoing a failed primary esophageal anastomosis at other hospitals.The age was 19 months,3 months plus 10 days and 7 months plus 16 days at the time of final thoracoscopic esophageal anastomosis.Follow-ups were conducted.Results Esophageal reconstruction was completed thoracoscopically without esophageal substitution.All of them stayed in pediatric intensive care unit(ICU)for ventilator supports for 7-10 days.One case of postoperative anastomotic leakage healed spontaneously after conservative measures with enteral nutrition via a jejunal feeding tube and inserting a supraesophageal suction tube for collecting saliva.Three cases were followed up for(3-12)months after operation.Esophageal stenosis was periodically managed with endoscopic balloon dilatation.All of them were fully orally fed with decent growth and satisfactory weight gain.Conclusions Type Ⅲa CEA is difficult to operate in stages.Endotension esophageal lengthening after phase Ⅰ surgery is effective for promoting esophageal growth and enhancing esophageal elasticity.Intraoperative indocyanine green fluorescent imaging in a second stage may assist in fistula localization,ensuring accurate separation and ligation of fistula,and avoinding damaging the surrounding tissues and effectively improve the prognosis.
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