End to End Anastomosis of Type A(long gap) Esophageal Atresia in 1,200 gram Premature Baby A Case Report

1,200gram 미숙아에서 Type A 식도 폐쇄증의 식도 단단문합술 -1례 보고-

  • Jo, Sam-Hyeon (Dept.of Thoracic and Cardiovascular Surgery, Chonnam University Medical School) ;
  • O, Bong-Seok (Dept.of Thoracic and Cardiovascular Surgery, Chonnam University Medical School) ;
  • Lee, Dong-Jun (Dept.of Thoracic and Cardiovascular Surgery, Chonnam University Medical School) ;
  • Choe, Yeong-Ryun (Dept. of Pediatrics, Chonnam Univ. Medical School)
  • 조삼현 (전남대학교병원 흉부외과, 의과대학 흉부외과학교실) ;
  • 오봉석 (전남대학교병원 흉부외과, 의과대학 흉부외과학교실) ;
  • 이동준 (전남대학교병원 흉부외과, 의과대학 흉부외과학교실) ;
  • 최영륜 (전남대학병원 소아과, 의과대학 소아과학교실)
  • Published : 1997.02.01

Abstract

The management of neonate with long gap atresia without a fistula(type A) is complex and controversial. Various esophageal reconstruction include use of native esophagus or replacement with colon, stomach and small bowel. A severe premature male, at 28 weeks gestation weighing 1.2kg, was born with type A esophageal atresia in Chonnam University Hospital. Initial treatment consisted of gastrostomy under the local anesthesia and suctioning of proximal pouch, and than underwent delayed esophageal end to end anastomosis. A minimal leakage and mediastinitis ocurred postoperatively, but was treated by adequate drainage and negative suction from the leakage site through the gastrostomy. The patient was discharged in good general condition and normal weight of 5.4kg after 4 months after the surgery.

긴 간격(longgap)의 A형 식도 폐쇄증을 가진 신생아의 치료는 복잡하고 아직까지 이견이 많아, 본래의 식도나 위, 소장, 대장 등을 이용한 치환술로 다양한 식도 재건술이 시행되고 있다. 저자는 long gap의 A형 식도 폐쇄증을 가진 재태기간 28주, 체중 1.2kg의 미숙아에서 식도 단단문합술을 시행하여 좋은 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다. 1차 처치로 위루술를 하고 2차로 식도 단단문합을 시행하였다. 술후 제한된 문함부유출과 종격동염이 발생하였으나 흉관을 통한 적절한 배액(drainage)과 동시에 위루술을 통하여 문합부유출부위에 음압 (negative pressure)을 걸어 지속적 인 흘인(suction)으로 치료하여 호전되었다. 환아는 건강하게 퇴원하였으며 술후 4개월이 지난후 5.4kg으로 체중의 증가가 있었다.

Keywords

References

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