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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.
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Congenital esophageal atresia with or without tracheoesophageal fistula is a relatively common and serious congenital gastrointestinal anomaly, which can be surgically repaired to achieve long-term survival in the majority of patients.However, various consequent long-term complications would affect the physical and mental health of patients, thus inducing a decline in their quality of life.In this study, the present status and advances of diagnosis and treatment of these complications were reviewed, in an attempt to further explore the long-term complications after congenital esophageal atresia.
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Objective To investigate the clinical efficacy of magnetic compression anastomosis for congenital esophageal atresia and stenosis.Methods The retrospective and descriptive study was conducted.The clinical data of 4 children who underwent magnetic compression anastomosis for congenital esophageal atresia and stenosis in the Northwest Women and Children's Hospital from December 2017 and February 2019 were collected.There were 2 males and 2 females.The children were aged 11 days,7 days,5 days,and 3 years,respectively.The children underwent magnetic compression anastomosis.Observation indicators:(1) surgical and postoperative situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect food intake and complications of children up to May 2019.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M (range).Results (1) Surgical and postoperative situations:four children underwent magnetic compression anastomosis successfully.Of the 4 children,3 with esophageal atresia underwent open tracheoesophageal fistula repair and endoscopeassisted magnetic compression anastomosis,and 1 with congenital esophageal stenosis underwent endoscopic gastrostomy combined with magnetic compression anastomosis.The operation time of 4 children was (2.3±0.9) hours.The length of esophageal blind ending in the 3 children with esophageal atresia and length of esophageal stenosis were in the children with esophageal stenosis 30-35 mm and 8 mm.Four children has good magnet apposition,and time of postoperative magnet removal was (29± 10)days.Three children with esophageal atresia had oral removal of magnet,and 1 with esophageal stenosis had magnet removed by gastrostomy.One child complicated with postoperative fistula and anastomotic stenosis was cured by unobstructed drainage and nutritional support treatment.The duration of postoperative hospital stay was (39± 10)days.(2) Follow-up:4 patients were followed up for 3-17 months,with a median time of 10 months,and restored to oral intake after oral removal of magnet and removal of magnet by gastrostomy on the days 14-36 postoperatively.One child was detected anastomotic stenosis by esophagography at the postoperative 3 months,and was improved after esophageal dilatation.The other 3 children recovered to normal connectivity of esophagus postoperatively and maintain unobstructed.Four children had normal eating,without dysphagia or other serious complications.Conclusion Magnetic compression anastomosis is safe and feasible for congenital esophageal atresia and stenosis,with good short-term efficacy.
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Objective To study the value of MSCT in the diagnosis of neonatal type (Ⅲ) congenital esophageal atresia.Methods MSCT data of 25 cases with neonatal type (Ⅲ) congenital esophageal atresia confirmed by surgery and pathology were analyzed retrospectively.The full preparation before examination and the image post-processing function were checked,and MSCT data were compared with the findings of surgery.Results By full preparation and application of M PR,SSD technology after scanning,the esophageal proximal blind end,and the distance between the two esophageal blind ends were clearly displayed,furthermore,the opening position,morphology and diameter of the distal tracheoesophageal fistula were also showed,and bronchial tree morphology and inflammation in the lung can be visible.Conclusion MSCT full preparation and application of image post processing function are potential to the clinical diagnosis of congenital esophageal atresia and tracheoesophageal fistula.
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Objective To explore the clinical value of sagittal CT scan in the diagnosis of congenital esophageal atresia and tracheoesophageal fistula(CEA-TEF).Methods Sagittal CT scanning was performed in 1 7 neonates with clinically suspected CEA-TEF preoperatively. Post-processing methods included multiple planar reconstruction(MPR)and volume rendering(VR).The CT manifestations were compared with the surgical findings.Paired-samples t test and Kappa identity analysis were used to analyze the consistency between two esophageal pouches and position of fistula.Results Among 1 7 cases,sagittal CT images clearly showed the distance between two esophageal pouches and position of fistula.Based on Gross classification,2 cases were included in type ⅢA(11.8%),and 15 cases in type ⅢB(88.2%).The results were satisfactory with the surgical findings with 100% accuracy.The distance between two esophageal pouches determined by VR and MPR had no remarkable differences(t=0.991,P>0.05).The position of fistula determined by VR and MPR had high consistency with the surgical findings (Kappa≥0.75).Conclusion Sagittal CT scanning can significantly limit scanning range and reduce the radiation dose as well as improve image quality,and accurately display and assess the distance between two esophageal pouches and position of fistula in CEA-TEF.It has important application value in diagnosing CEA-TEF in neonates.
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Objective To investigate the application of permissive hypercapnia in the thoraco-scopic surgery of neonates with congenital esophageal atresia.Methods Thirty newborns with con-genital esophageal atresia,seventeen males,thirteen females,aged 1-5 days,weighing 1.42-3.28 kg, ASA physical status Ⅱ or Ⅲ,undergoing the thoracoscopic surgery,were randomly divided into group P and group C,n =1 5 in each group.The newborns were intratracheally intubated and adopted intravenous anesthesia combining inhalational anesthesia.FiO 2 100%,fresh gas flow 2 L/min,then adjusted the respirator parameters according to the results of airway pressure and arterial blood gas a-nalysis.Group P maintained PaCO 2 ranging at 60-80 mm Hg,group C maintained PaCO 2 ranging at 35-45 mm Hg.Arterial blood gas analysis was conducted respectively before artificial pneumothorax (T0 ),1 5 min after foundation of artificial pneumothorax (T1 ),30 min after foundation of artificial pneumothorax (T2 ),60 min after foundation of artificial pneumothorax (T3 )and 1 5 min after artifi-cial pneumothorax (T4 ).Two hours after surgery,a chest X ray photograph was taken to observe pneumothorax.The time from the end of the surgery to the ventilator weaning was recorded. Results At T1-T3 ,the PET CO 2 [(73.93 ± 3.53 )mm Hg vs.(41.53 ± 1.59 )mm Hg,(73.46 ± 3.04)mm Hg vs.(41.30±1.29)mm Hg,(74.13±2.85)mm Hg vs.(41.67 ±1.35)mm Hg]in group P were greatly higher than those in group C (P <0.05);the arterial blood pH value of group P (7.25±0.02 vs.7.38 ± 0.03,7.24 ± 0.01 vs.7.37 ± 0.03,7.25 ± 0.01 vs.7.38 ± 0.02 )were greatly lower than those in group C (P <0.05);PaCO 2 [(74.80±2.45)mm Hg vs.(41.93±1.39) mm Hg,(75.33±2.1 9)mm Hg vs.(42.01±1.31)mm Hg,(75.20±2.08)mm Hg vs.(42.13± 1.1 9)mm Hg ] were greatly higher than those in group C (P < 0.05 ).The incidence of pneumothorax of group P was obviously lower than that of group C (6.7% vs.40.0%,P <0.05 ). There was no statistically significant difference of the time from the end of surgery to the ventilator weaning [(3.6±0.6)d vs.(3.5 ±0.6)d]between the two groups.Conclusion Permissive hyper-capnia significantly reduces the incidence of pneumothorax in the thoracoscopic surgery of neonates with congenital esophageal atresia.Permissive hypercapnia (PaCO 2 60-80 mm Hg)can be safely ap-plied to the thoracoscopic surgery of neonates with congenital esophageal atresia.
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Objective: To investigate the risk factors for mortality in neonates with congenital esophageal atresia (CEA) and simple congenital heart disease (CHD) including atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Methods The medical records of neonates with CEA and simple CHD who had surgery in Children’s Hospital of Chongqing Medical University from 1998 to 2013, were analyzed retrospectively. Factors including neonatal demographics, laboratory results and complications after surgery were compared between survivor and non-survivor groups. Results Seventy ifve cases were included in this study and the mortality was 10.67%(8/75). There was no signiifcant difference between non-survivor group (n=8) and survivor group (n=67) in factors such as gestational age, birth weight, age of admission, age at surgery, duration of surgery, full blood examination, serum electrolytes, blood gases, prevalence of septicemia, pneumothorax, and cold lesion syndrome. However, the prevalence of respiratory failure and heart failure in non-survivor group was higher than that in survivor group (75%vs. 9%, P=0.000;50%vs. 1.5%, P=0.000, respectively). Conclusions The poor outcome among neonates with CEA plus simple CHD might be associated with respiratory failure and heart failure.
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Objective To discuss the position nursing for neonates with type three congenital esophageal atresia after operation. Methods We selected 10 patients with type three congenital esophageal atresia from September 2004 to May 2007.The respirator, trachea catheter was removed after operation and the SpO2 was lower than 95% through head mask.Then the SpO2 was compared in different positions of patients,that is face forward,face lateral, face forward with hypsokinesis,face lateral with hypsokinesis. Results All the ten patients survived the operation.The Sp02 in the four positions under oxygen inhalation were (90.30±0.95)%, (89.90±0.74)%, (96.80±1.48)%, (95.90±0.88)%.The former two results were statistically different from the latter two results (P ＜ 0.01). Conclusions The position of face forward with hypsokinesis and face lateral with hypsokinesis facilitated the transition to natural respiration for patients with type three congenital esophageal atresia after remove of respirator and trachea catheter.This could prevent the incidence of complications and the probability of reuse of respirator.
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Background: Congenital esophageal atresia isn\u2019t uncommon malformation in newborn emergency. Its consequence is loss the ability of eating and poly infection in lung as well as newborn respiratory insufficiency. Objectives:This study aims to learn about the clinical characteristics, radiological and some risk factors for mortality of the congenital esophageal atresia at National Hospital for Pediatric. Subjects and method:A descriptive and retrospective study was conducted on 68 cases with atresia of the esophagus, hospitalized in the National Hospital for Pediatrics for 3 years from 1st January 2003 to 31st December 2005. Results:64.7% of cases hospitalized at 1 day of life, positive diagnosis was 45.6% at levels 1 and 2. The greater part clinical signs appeared in the 12 hours of life. Combination congenital malformations was seen in25% congenital esophageal atresia. Type III was more frequent (85.3%). Underprivileged factors were weight <2500g at birth, with associated diseases (infection, malformation), balance disorder of acid - base, hydro - electronics, respiratory distress by ventilator supported, time for surgery after 3 days. Conclusion: A further study should be carried out for confirmation of clinical characteristics, radiological and some risk factors of congenital esophageal atresia to help doctor give out accurate diagnosis to cure the patients.\r\n', u'\r\n', u'
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Objective:To probe the anesthesia methods and management of respiration in the operation on congenital esophageal atresia accompanying tracheo-esophageal fistula.Methods:Retrospective analysis was used to study anesthesia process during operation of 9 cases.Results:Vital signs of 7 cases during operation were stable.No increased airway resistance or bronchospasm was observed.Seven patients who received endotracheal intubation and controlled respiration after slow induction developed no significant atelectasis or more severe pneumonia on post -operation X-ray.Stomach gassiness happened in two patients who received fast induction.Gradually increased airway resistance was observed and more severe pneumonia accompanying atelectasis happened in the two patients.No hypothermia happened among these 9 patients owning to right keeping warm.Seven patients were discharged in good health.The families of two patients gave up treatment.Conclusion:Pulmonary complication can be reduced effectively and the same stable anesthesia can be obtained by combining the existing autonomous breath after slow induction with controlled breath after blocking up fistula cannula.The effective aspiration,keeping warm, intensive transfusion and consummate analgesia during and after the operation are very important to guarantee the security for patients.
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Objective To report the results of balloon catheter dilation in 13 infants with anastomotic stenosis after surgical correction of esophageal atresia. Methods Thirteen cases of anastomotic stenosis after surgical correction of esophageal atresia were enrolled, age ranging from 3 to 10 years. Barium esophagography before balloon dilation showed the diameter of esophageal stenosis ranging 1 to 3 mm and the stenosis was dilated by using balloons of 6 to 12 mm diameter. Results All the 13 cases obtained complete resolution of the stenosis after dilation for twice or thrice. There was no esophageal perforation or other complications with a period of clinical symptomless of 6 to 30 months. Conclusions Ballon catheter dilation is a simple, safe and reliable method for treating anastomotic esophageal stenosis in infants.