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先天性食管闭锁患儿术后吞咽困难危险因素分析

Dysphagia in Patients Undergoing Esophageal Atresia Surgery: Risk Factors and Strategies for Management

李爽爽;谢川平;赵勇;廖俊敏;刘恒鑫;黄金狮

1:国家儿童医学中心首都医科大学附属北京儿童医院新生儿外科

2:国家儿童医学中心首都医科大学附属北京儿童医院耳鼻咽喉头颈外科/儿童耳鼻咽喉头颈外科疾病北京市重点实验室

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摘要

目的探讨先天性食管闭锁患儿术后吞咽困难相关危险因素。方法对2016年7月-2023年8月于首都医科大学附属北京儿童医院接受先天性食管闭锁手术患儿103例的临床资料进行回顾性分析。结果 103例先天性食管闭锁患儿中，74例术后出现吞咽困难(71.8%,74/103),其中持续时间0～≤6月17例，6～≤12月38例，>12月19例。术后吞咽困难单因素分析结果提示：一期手术(χ~2=4.017,P=0.045)、腔镜手术(χ~2=8.315,P=0.004)、长段缺失(χ~2=10.975,P<0.001)、胃食管反流(χ~2=16.973,P<0.001)、声带麻痹(χ~2=4.017,P=0.045)、气管软化(χ~2=5.778,P=0.016)、会厌运动不协调(χ~2=10.420,P=0.001)与术后吞咽困难发生相关；进一步二元logistic回归分析提示：腔镜手术(OR=24.373,P=0.016)、气管软化(OR=17.556,P=0.010)、吻合口狭窄(OR=20.453,P=0.032)是增加术后吞咽困难发生率的独立相关危险因素。进一步根据吞咽困难持续时间分层，多因素无序多分类logistic回归分析结果提示，气管软化(OR=16.883,P=0.007;OR=4.337,P=0.045)、长段缺失(OR=0.040,P=0.049;OR=0.040,P=0.036)、会厌运动不协调(OR=0.127,P=0.039;OR=0.510,P=0.028)与吞咽困难持续时间密切相关。结论吞咽困难是先天性食管闭锁患儿术后常见并发症，腔镜手术、长段缺失、气管软化和吻合口狭窄是导致术后吞咽困难的独立危险因素，而气管软化、长段缺失、会厌运动不协调与吞咽困难持续时间密切相关。

关键词

吞咽困难;先天性食管闭锁;危险因素;儿童

基金项目(Foundation):

首都临床诊疗技术研究及转化应用项目(Z211100002921062)

作者

李爽爽;谢川平;赵勇;廖俊敏;刘恒鑫;黄金狮

参考文献

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吞咽困难先天性食管闭锁危险因素儿童

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李爽爽谢川平赵勇廖俊敏刘恒鑫黄金狮