Thoracoscopic operation of the third type of esophageal atresia : a single center's experiences / 中华胸心血管外科杂志

ABSTRACT

Objective Conclusion thoracoscope surgery clinical data and correcting Ⅲ esophageal atresia(EA) and discuss the feasibility and clinical effect.Methods 24 cases confirmed the third type of esophageal atresia were retrospectively analyzed.There were 12 male and 12 female.9 cases were type Ⅲa EA and 15 cases were type Ⅲb EA.The weights were from 1.9 kg to 3.6 kg,mean weight was 2.56 kg.The age were from born to 8 days,the mean age was 2.5 days.Before operation esophageal contrast study was carried out,also ultrasonography was routinely used to evaluate heart and abdominal viscera.Results The diagnosis of third type EA was confirmed by esophageal contrast study with a blind proximal end of the esophagus and air inflation in the gut.There were 3 cases with proximal blind pouch at the 2nd vertebrate level and the other 21 cases at the 3rd to 4th vertebrate level.All the cases except one just beginning transferred to open operation because hypo-SpO2 was corrected by thoracoscopic operation.The operation time was from 110 min to 280 min,and the mean time was 120 min.The azygos vein in the former 14 cases divided and was preserved in the latter 10 cases.So the stump of the tracheoesophageal fistula (TEF) of the latter 10 cases were covered by the preserved azygos vein or plus the parietal pleura.One Ⅲa type EA could not be repaired by the radical operation and abandoned.5 cases with anastomotic leakage were cured by conserved tactics.2 cases with early TEF recurrence were initially supported by enteral nutrition by putting nasogastric jejunal tube and corrected by the 2nd stage operation.5 cases with anastomotic stricture were dilated by two times.Conclusion It is feasible to correct the Ⅲ type EA by thoracoscopic operation with good results and nice appearances.The preserved azygos vein to cover the stump of the TEF may contribute to reduce the recurrence of TEF.