ABSTRACT
Objective:To investigate the clinical characteristics of congenital esophageal atresia with gastric perforation, and to improve pediatricians′ understanding of this disease.Methods:The clinical data of five neonates with congenital esophageal atresia and gastric perforation treated in the neonatal intensive care unit of the Affiliated Hospital of Qingdao University from 2012 to 2022 were analyzed retrospectively.Results:Among the five neonates, four were boys and one was girl.The gestational age was 28 + 5 to 37 + 6 weeks, the birth weight was 1 100~2 350 g. All of them had dyspnea and feeding difficulties after birth.Gastric perforation occurred in three cases during invasive mechanical ventilation, one case during non-invasive ventilation, and one case during nasal catheter oxygen inhalation.Emergency primary gastric repair was performed, followed by secondary esophageal anastomosis.All the patients were cured and discharged from hospital. Conclusion:Gastric perforation is a rare complication of congenital esophageal atresia, which is more common in premature infants and low birth weight infants.Mechanical ventilation may promote the occurrence of gastric perforation.If gastric perforation is complicated, repair should be performed as soon as possible, and esophageal anastomosis surgery should be performed early after stability to improve the final outcome.
ABSTRACT
Objective:To evaluate therapeutic effect of membrane-covered self-expanding metallic stent on high-positioned advanced esophageal carcinoma,esophagotracheal fistula and anastomotic stricture,and relevant problems to stent implantation.Methods:23 membrane-covered self-expandable stents were implanted in 23 patients with high-positioned advanced esophageal carcinoma (12 cases),esophagotracheal fistula (6 cases) and high-positioned anastomotic stricture (5 cases).The implantation of the stents was performed under endoscope or perorally.Results:The severity of dysphagia was reduced,and life quality of the patients was improved significantly.One stent had to be taken out for severe pain. The positions of 3 stents were successfully adjusted by endoscope for improper position after the first implantation.6 patients suffered from the disorder of pharyngeal function after implantation,among which 5 were cured,and 1 had the stent taken out.Conclusion:Membrane-covered self-expanding metallic stent is effective,safe and easy to insert,especially for patients with the stricture of the high-positioned advanced esophageal carcinoma,and the esophagotracheal fistula.However stent is not the first choice for the treatment of anastomotic stricture.Post-implantation pain,improper position of stent and the disorder of pharyngeal function can be solved by active management.