Chuyển vị dạ dày: Hồi cứu và kinh nghiệm bước đầu

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Tác giả: Tuyến Trần, Minh Chiều Vương

Ngôn ngữ: Vie

Ký hiệu phân loại: 572 Biochemistry

Thông tin xuất bản: Journal of Pediatric Research and Practice, 2022

Mô tả vật lý: 155-161

Bộ sưu tập: Metadata

ID: 420923

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Phẫu thuật chuyển vị dạ dày thay thế thực quản đang được sử dụng ngày càng phổ biến ở trẻ em nhờ ưu điểm về lượng máu nuôi dồi dào và khả năng kéo dãn của dạ dày. Nghiên cứu này nhằm hồi cứu và đánh giá những kinh nghiệm bước đầu về kỹ thuật chuyển vị dạ dày ở trẻ có thực quản bất thường do bẩm sinh hay mắc phải. Phương pháp Hồi cứu hồ sơ và theo dõi tất cả các trẻ được phẫu thuật chuyển vị dạ dày từ 01/01/2018 đến 15/06/2019 tại Bệnh viện Nhi đồng 2. Những thông tin được ghi nhận gồm đặc điểm lâm sàng, phẫu thuật, biến chứng và theo dõi sau phẫu thuật. Kết quả Có 9 bệnh nhi được ghi nhận gồm 8 trường hợp teo thực quản gián đoạn dài và 1 trường hợp hẹp thực quản sau bỏng thực quản do hóa chất. Tuổi trung bình lúc phẫu thuật là 26 tháng. Không có biến chứng nào xảy ra trong lúc phẫu thuật. Có 2 trường hợp tử vong, một trường hợp tử vong trong giai đoạn hậu phẫu do sặc sữa dẫn đến suy hô hấp cấp, trường hợp còn lại tử vong sau khi xuất viện. Xì miệng nối xảy ra ở 3 trường hợp (33%), tất cả được điều trị bảo tồn thành công. Hẹp miệng nối xảy ra ở 2 trường hợp (22%). Trong quá trình theo dõi, có 1 trường hợp biểu hiện trào ngược dạ dày thực quản, đáp ứng tốt với điều trị nội khoa. Thời gian cho ăn lại trung bình là 22 ngày và thời gian nằm viện trung bình là 33 ngày. Kết luận Chuyển vị dạ dày là một lựa chọn phù hợp cho phẫu thuật thay thế thực quản ở trẻ em. Tất cả các trường hợp đều thành công trong việc khôi phục khả năng ăn uống đường miệng. Tỉ lệ xì miệng nối là 33%, và 22% trường hợp cần nong thực quản để giải quyết biến chứng hẹp miệng nối sau mổ. Trào ngược dạ dày thực quản là một biến chứng quan trọng, cần được theo dõi và phòng ngừa, đặc biệt ở giai đoạn hậu phẫu sớm. Việc theo dõi dài hạn là cần thiết để đánh giá các biến chứng lâu dài của phẫu thuật này., Tóm tắt tiếng anh, Gastric transposition has been widely utilised in children as an esophageal replacement method because of the stomach's rich vasculature and stretch ability. This research basically aims to review and evaluate our initial experiences of gastric transposition in children with congenital or acquired abnormalities of esophagus. Methodology All children underwent gastric transposition from 1 January 2018 to 15 June 2019 at Children's Hospital No.2 were retrospectively recorded and subjected to continual follow up. We reviewed the clinical features, surgical procedures, complications and follow-up. Results We recorded 9 patients including 8 cases with long-gap esophageal atresia and 1 case with caustic ingestion with persistent stricture. Mean age at the time of operation was 26 months. There was no major complications during the surgery. There were 2 deaths in the series, one child died in the early postoperative period from pulmonary aspiration leading to respiratory failure, and the other died after discharged from hospital. Anastomotic leakage occurred in 3 cases (33%), all of which resolved without intervention. Anastomotic stricture occurred in 2 cases (22%), which required dilatation once or twice. In terms of followup, there was 1 case showed symptoms of gastroesophageal reflux which was resolved by medicine. The mean refeeding time was 22 days and discharged time was 33 days. Conclusions Gastric transposition is an appropriate alternative for esophageal replacement in children. Oral feeding was achieved in all cases. The anastomotic leakage ratio was 33%, and 22% of the patients needed anastomotic dilatation for stricture. Gastroesophageal reflux after this procedure is an essential complication and must be monitored and prevented, especially in early postoperative period. Longer follow-up would be necessary to evaluate other long-term outcomes.

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