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Objective:To analyze the short-term and medium-term survival status of children with congenital esophageal atresia, and to provide reference for clinical multidisciplinary management of children with congenital esophageal atresia.Methods:The clinical data of neonates with type Ⅲ congenital esophageal atresia who were operated in our hospital between November 2007 to November 2018 and followed up in this hospital were analyzed retrospectively.Results:Among the 62 cases, 16 cases were discharged automatically, 1 case died, and 45 cases were included in the short-term follow-up. 35 cases were classified as gross Ⅲa, 10 as Ⅲb, 5 as long segment type, 44 patients accepted one-stage surgery, 1 infant accepted delayed operation, 9 infants received second operations. Anastomotic leakage occurred in 8 cases (17.8%), anastomotic stenosis in 11 cases (24.4%), recurrence of tracheoesophageal fistula in 2 cases (4.4%), blood flow infection in 14 cases(31.1%), incision infection in 4 cases (8.9%). The medium-term survival status of 38 cases: 2 cases died of aspiration, 29 cases (76.3%) of anastomotic stenosis underwent esophageal dilatation, 5 cases (13.2%) of dysphagia when 1.5 years old, 6 cases (15.8%) of malnutrition. After multidisciplinary collaboration, the survival rate increased (57.1% vs. 85.3%, P=0.013), and the incidence of anastomotic leakage decreased (46.4% vs. 20.6%, P=0.03). Conclusion:The quality of life of children with congenital esophageal atresia can be improved by multidisciplinary cooperation and standardized postoperative follow-up.
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Objective To summarize the clinical experience of surgical treatment for complete atrioventricular septal defect in infants.Methods From December 2013 to June 2004,56 patients aged from 53 days to 12 months with complete atrioventricular septal defect were undergone operations.All patients were diagnosed by 2D-echocardiography,and 18 patients underwent cardiovascular computed angiography (CTA).Rastelli type A had 44 cases,type B 3 cases,and type C 9 cases.The single pericardium patch repair was used for 37 cases,the two-patch repair for 3 cases,and the modified single-patch repair for 16 cases.The time of mechanical ventilation was 26 to 172 hours,and the time of staying at Intensive Care Unit (ICU) was 3 to 19 days.Results There were 5 early deaths caused by severe low cardiac output in 2 cases,renal failure in 2 cases,and severe pulmonary inflammation in 1 case.One late death was due to severe mitral regurgitation with pneumonia and heart failure.The operative mortality was 10.7％.A total of 47 patients was followed-up for 3 months to 5 years after surgery and their heart function was satisfactory.Conclusions The operation should be done between 6 months and 1 year when the diagnosis of complete atrioventricular septal defect (CAVSD) is clear.Its early surgical intervention is satisfactory.The result of surgical treatment for CAVSD depends on both probing intracardiac anatomy carefully and complete correction of associated cardiac abnormalities.
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Objective To summarize the experience of modified Nuss procedure with thoracoscope for the correction of pectus excavatum in children. Methods Forty-nine pediatric pectus excavatum were treated by modified Nuss procedure with thoracoscope from August 2006 to July 2008, the age ranged from 3 to 18 years, 36 patients were symmetric pectus excavatum and 13 patients were asymmetric pectus excavatum. Results The operations in all patients were successful. Only 1 case used two bars,other 48 cases used one bar. There were no major complications such as cardiac perforation occurred during the operation. The earlier complication was pneumatothorax in 1 case, and the average blood loss was less than 10 ml. The postoperative hospital length of stay was 6-8 days. All patients had a satisfied deformity correction and no needs of transfusion. Therapeutic results evaluation showed excellent in 43 patients and good in 6 patients. All patients were followed up in 0.5-23.0 months without bars displacement, 1 ease had chronic intermittent pain for 2 months. The bar had been removed in 1 case after operation 23 months who still kept in excellent result. Conclusions Modified Nuss procedure is easy to performed with minimal invasion and satisfied deformity correction. Thoracoscopic visualization facilitates the safety of this technique.