Clinical Application Value Of A New Treatment Method For The Broken End Of Esophagotracheal Fistula In Preventing Recurrence Of Esophagotracheal Fistula After Esophageal Atresia Surgery

Objective :To explore the clinical value of a new treatment method of esophago tracheal fistula(continuous suture combined with mediastinal pleural covering embedding)in preventing the recurrence of esophago tracheal fistula after thoracoscopic esophageal atresia,in order to provide new ideas and strategies for reducing or even avoiding the occurrence of esophago tracheal fistula after thoracoscopic esophageal atresia.Method:The clinical data of 110 children with congenital esophageal atresia who underwent thoracoscopic surgery in neonatal surgery of my Hospital from April 2014 to April 2021 were retrospectively analyzed to explore the effect of different treatment methods of broken end of esophago tracheal fistula on the recurrence of postoperative esophago tracheal fistula,According to the different treatment methods of esophagotracheal fistula,they were divided into three groups: group A(n = 40)with one ligation and one suture;In group B,40 cases were clamped with Hem-o-lok;Group C,30 cases,continuous suture embedding;All patients were followed up for more than 6 months.There was no case of loss of follow-up or death,The recurrence rate of postoperative esophago tracheal fistula,the incidence of postoperative esophago anastomotic fistula,and the time to deal with the broken end of esophago tracheal fistula were compared among the three groups.Result:Among 110 cases,9 cases of esophago tracheal fistula recurred,and the total recurrence rate was 8.2%;Anastomotic leakage occurred in 15 cases,and the total incidence of anastomotic leakage was 13.6%.The recurrence rates of tracheal fistula in the three groups were 5(12.5%),4(10%)and 0(0%)respectively;The incidence of anastomotic leakage was 6(15%),5(12.5%)and 4(13.3%)respectively.Two tests were used between the two groups.The recurrence rate of tracheal fistula in group C was lower than that in group A and B(P < 0.05);There was no significant difference in the incidence of anastomotic leakage among the three groups(P > 0.05).The time spent in dealing with the broken end of esophago tracheal fistula was(15.5 ± 4.5)mins,(7.5 ± 2.5)mins and(26.5 ± 5.5)mins respectively.By paired t-test between each two groups,the time spent in group C was higher than that in group A and group B respectively.Conclusions :Although the new treatment of esophagotracheal fistula is more longer than the ligation and suture and Hem-o-lok clamping method adopted by pediatric surgeons at home and abroad,However,it can avoid or reduce the incidence of postoperative esophago tracheal fistula.Because of the small number of case studies in a single center,it still needs further demonstration of multi center big data.