目的:探讨胸腔镜技术治疗先天性食管闭锁术后食管狭窄的可能影响因素,以规避部分有害因素,降低食管狭窄的发生率。方法回顾性分析2008年10月至2013年4月本院经胸腔镜治疗的46例先天性食管闭锁患儿临床资料,其中18例术后诊断为食管狭窄;拟定可能影响因素包括:手术时体重、手术日龄、缝合方式、胸腔镜手术学习曲线、食管盲端距离、呼吸机使用时间、胸腔引流管的使用、术后GER、吻合口漏及术后进食时间;按各因素条件使用Excel表将46例患儿相关资料建立数据库,先行单因素检验,再将可能的危险因素纳入多因素非条件Logistic模型,筛选出影响术后食管狭窄的危险因素。结果手术日龄、手术体重及胸腔镜手术学习曲线在单因素分析中存在差异,而食管盲端距离、吻合口漏及术后GER在单、多因素分析中均有不同,差异有统计学意义(P<0.05)。结论经胸腔镜治疗先天性食管闭锁术后食管狭窄主要与食管盲端距离、吻合口漏及GE R有关,预防措施主要是降低食管吻合口的紧张度,减少食管吻合口漏的发生和术后积极治疗GE R。
Objetive To explore the possible influential factors of anastomotic stricture in order to avoid the harmful factors,and to reduce the rate of anastomotic stricture after thoracospic repair of congenital esophage-al atresia. Methods Retrospective analysis was given to 46 cases of congenital esophageal atresia underwent thoracoscopic procedures in our hospital from October,2008 to April,2013.Among the 46 cases,18 were diag-nosed as esophageal stricture,which may be owing to the weight during the operation,the age,methods of anasto-mosis,thoracoscopic operation learning curve,gap length,ventilation time,drainage tube,GER,anastomotic leak-age,eating time,etc.A clinical database of 46 cases was set up with Excellaccording to all of those factors.The risk factors were identified through univariate analysis and multivariate logistic regression analysis. Results Dif-ferences were found in weight,age,thoracoscopic operation learning curve in univariate analysis,and in anasto-motic lea