The Clinical Analysis Of Neonatal Long Gap Esophageal Atresia

Objective:By summing up the experience of surgical treatment of neonatal longgap esophageal atresia, we explore the factors affecting children surviveand the best surgical treatment options in order to improve the level ofclinical diagnosis and treatment of this disease as well as reduce mortality.Materials&Methods:Retrospectivly review94cases diagnosed as congenital esophagealatresia which accepted surgical treatment simuleaneously from January1,2008to December31,2012in Chongqing Medical University Children’sHospital. Of which the long segment type is34cases,16males,13females. The gestational age of the children is34.85to42.85weeks and38.85±1.87weeks on average; birth weight between1800to3900g,2702.5±479.3g on average, including5premature,8low birth weightnewinfant. The hospital stay is9to79days,25.15±13.48days on average;postoperative ICU stay2to31days,12.15±7.83days on average. Age of be hospitalized is1to544Hours (average:64.28±118.4h), age at surgery1.96to27.67h (average::6.71±5.44d). Of the34cases, there are27casesamalgamated with congenital cardiovascular malformations,3cases ofurinary tract malformations,1case with intestinal malformation,4caseswith nervous-system problem and4cases with none. Postoperativecomplications:25cases with pneumonia,8cases with pneumonia andatelectasis,18cases with mild anastomotic stenosis,6cases withanastomotic fistula, while pleural effusion in3cases, pneumothorax in8cases and sepsis in1case.At the same time analysis the relationship between factors includinggestational age, birth weight, malformations, postoperative complicationsand survival rate of children.Results:1.(1)Of the27full-term newborn,25cases survived while2gave up,7non-full-term children,3survived while4gave up, the difference betweenthe two groups was statistically significant (p <0.05);(2)Of the26normalbirth weight children,24survived, and2gave up,8low birth weightinfants,4patients survived while4gave up, the difference of survival ratewas statistically significant (p <0.05);(3) Of the22cases merge multiplemalformations,16survived and6gave up;8with single malformations allcured, the difference between the two was not statistically significant (p>0.05)(4) Of the13postoperative severe pneumonia (multi-drug resistant infections),8cases survived and5gave up; of the rest20survived and1case of abandoned, the survival difference was statistically significant (p<0.05);of the6anastomotic fistula patients2survived cases (33.3%),gave up, children with more than28cases,26survived,2gave up, thedifference between the two groups was statistically significant (p <0.05).2. In the Whole group,24cases have polyhydramnios history, anddiagnosed after delievely;19patients was diagnosed by gastrointestinalangiography, of which7cases was discovered pre-hospital and12casesafter admission;8patients was confirmed by chest64-slice CTthree-dimensional reconstruction while7cases was diagnosed by the twoways.of the group1case of type I CEA was confirmed by the esophagusangiography, the chest CT three-dimensional reconstruction and stomachangiography.3.5cases of type I CEA Admission underwent gastrostomy andproximal drainage, except one case which combined multiplemalformations, respiratory failure gave up treatment, the remaining fourcases accepted colon esophagus surgery after2weeks,(1case with righthalf colon and3cases with the left colon),3patients were cured,1patientwas gave up due to severe lung infection associated with complexcongenital heart disease (DORV) and economically disadvantaged. TypeIIIA CEA were cut tracheoesophageal fistula, esophageal anastomosis,1case of esophageal stenosis underwent gastrostomy because of the remote stricture, in addition to suffering from congenital heart disease with severepulmonary infection3cases give up, while1case mergered duodenalstenosis required surgery and severe pneumonia but parents gave up, therest25cases were cured.4. The complications were all cured when28survived children leavehospital. After then accepted esophagus expansion,1cases with4times,2cases with3times,2cases with2times,1patient accepted esophagealreconstruction anastomosis after10months because anastomotic leakageand stenosis. The patients were followed up for0.5to3years, children allhave abnormal growth and development.Conclusion:1. Gestational age and birth weight are risk factors which affect thechildren survival.The severity of postoperative complications can affect thesurvival rate of children,of which severe pneumonia, anastomotic leakageare significant risk factors.2. Most of the LGEA patients’ diagnosis relies on clinical manifestationsand X-ray, esophagus angiography, the CT reconstruction can be moredetailed understanding of the type of esophageal, the relationship betweenthe distance, the location of the blind side and relationship of trachea andesophageal, in type I CEA, esophagus binding stomach angiography(lipiodol or barium) can further clarify the blind end of the pitch and thedevelopment of the gastrointestinal tract. 3.When Neonatal long gap esophageal atresia after diagnosis, type IIIACEA can cure once for all, the type I esophageal atresia need gastrostomyand proximal esophageal suction drainage as early as possible, after2weeks to take the colon esophagus radical surgery, can be Get a goodtherapeutic effect.