Abstract: 【Abstract】 Objective To explore the clinical experience of thoracoscopic surgery in the treatment of type Ⅲ esophageal atresia in low birth weight infants, and to summarize its feasibility and clinical effect. Method Retrospective analysis of the clinical data of 25 children with low birth weight type Ⅲ esophagealatresia who underwent thoracoscopic surgery in Children's Hospital Affiliated to Capital Institute of Pediatricsfrom January 2018 to February 2023 were performed, including 14 males, 11 females, 18 cases of type Ⅲa and 7 cases of type Ⅲ b. Their birth weights ranged from 1 350-2 460 g with a mean of (2 082±331) g. Therewere 2 cases with very low birth weight, 1 350 g and 1 440 g. There were 8 full-term infants and 17 preterminfants with a birth gestational week of 30+3- 38+6 weeks. At the time of operation, the youngest patient was 4 h after birth and the largest patient was 20 d after birth. Five cases required preoperative invasive ventilator support. Preoperative esophagography was performed to confirm the diagnosis, and the esophagotracheal fistula ligation + esophageal end to end anastomosis was done by thoracoscopy. Result 21 cases were completed the operation under thoracoscopy, and 4 cases were operated in open-heart surgery. The operative time was 143-300 min, with an average of (189±40) min. Postoperative ventilator use time was 18-841 h, with a median of 168 h. Hospitalization time was 8-83 d, with a median of 30 d. Two cases of postoperative anastomotic leak were treated conservatively for 1-3 weeks and then healed spontaneously. One case of recurrent esophagotracheal fistula was treated conservatively and healed spontaneously. In 12 cases of postoperative anastomotic stenosis, regular gastroscopic dilatation of the esophageal balloon was performed, and the symptoms were significantly relieved. One case with polycystic kidney and renal insufficiency developed severe infection and renal failure 7 d after surgery, and died after the family gave up treatment.The remaining 24 cases were cured and discharged from the hospital. 24 cases were followed up for 1-60 months after surgery, with a median of 28 months. Two cases developed gastroesophageal reflux symptoms 4-5 months after surgery and underwent laparoscopic fundoplication. Conclusion Thoracoscopic surgery for low birth weight infants of type Ⅲ esophageal atresia is generally safe and effective, and no increase in postoperative complications is observed. With the improvement of surgical technique and perioperative management, thoracoscopic treatment of esophageal atresia in low birth weight infants can be carried out gradually.
2023, Vol. 11 
