目的 统计分析Ⅲ型食管闭锁与食管气管瘘(esophageal atresia and tracheoesophageal fistula,EA-TEF)术后气管食管瘘复发(recurrent tracheoesophageal fistula,RTEF)的高危因素,并计算高危因素预测RTEF的能力。方法 回顾分析2015年9月—2021年1 月我院EA-TEF患儿的临床资料,并根据术后是否气管食管瘘复发分成复发组(recurrent组,R组)及无复发组(not recurrent组,NR组),比较两组患儿的基本情况、开放手术或胸腔镜手术、手术时间、气管食管瘘结扎方式等术中情况,统计分析RTEF的高危因素,分析其预测RTEF的能力。结果 研究期间共纳入Ⅲ型食管闭锁患儿154例,男98例,女56 例,R组11例,NR组143例,单因素对比分析R组与NR组患儿除吻合口瘘外其余均无统计学差异,其中R组吻合口瘘6人,占该组54.55%;NR组13人,占该组9.10%,P<0.001;Logistic回归模型调整后可见有吻合口瘘相对于无吻合口瘘发生RTEF的风险增加12倍(OR=12.000,95%CI:3.216~44.771)。结论 RTEF与患儿基本情况、术中情况无关,与吻合口瘘显著相关,且有吻合口瘘的患儿出现RTEF风险是无吻合口瘘患儿的12倍。

Objective To statistical analyze the high-risk factors of recurrent tracheoesophageal fistula (RTEF) after the repair of type Ⅲ esophageal atresia and tracheoesophageal fistula (EA-TEF),and evaluate the ability of these high-risk factors predicting RTEF. Methods Retrospectively analyzed the clinical data of children with type Ⅲ EA-TEF in our hospital from September 2015 to January 2021. Patients were divided into two groups (recurrent and non-recurrent group,R and NR group) according to whether there was RTEF. The general situation of those patients, situation during surgery like open or thoracoscopic surgery,operation time,method of tracheoesophageal fistula ligation were compared. Those factors of two groups were analyzed, the high-risk factors of RTEF were summarized, and Logistic regression analysis on the high-risk factors was performed to analyze the ability of predicting RTEF. Results A total of 154 infants with type Ⅲ EA-TEF were included in the study, 98 males, 56 females. There were 11 cases in R group, 143 cases in NR group. Univariate comparative analysis was carried out on R group and NR group, and no statistical differences were found except in anastomotic fistula. There were 6 patients in R group with anastomotic fistula, accounting for 54.55%, and 13 patients in NR group, accounting for 9.10%,P< 0.001. After adjusting the Logistic regression model with the high-risk factors, there was 12-fold increase in the risk of RTEF with anastomotic fistula (OR=12.000, 95%CI: 3.216~44.771) compared with no anastomotic fistula. Conclusion RTEF was not related to patients' general situation or surgery situation, but significantly related to anastomotic fistula. Patients who with anastomotic fistula had a 12-fold increase in the risk of RTEF compared with no anastomotic fistula.

目的 观察表皮生长因子(EGF)在新生儿坏死性小肠结肠炎(NEC)患儿肠组织中的动态表达情况,探讨EGF在NEC病程中起到的保护作用。方法 选取15例NEC患儿行一期回肠造瘘手术治疗的回肠组织为实验组(NEC组),将以上15例NEC患儿行二期回肠封瘘手术治疗的回肠组织为对照组(封瘘组),采用免疫组织化学技术检测,通过光密度测算软件(IPP)分析回肠组织中的EGF表达。结果 EGF主要表达于肠壁黏膜层,少量表达于黏膜下层、肌层。EGF在NEC组各层表达平均光密度值为:黏膜层(0.241±0.075),黏膜下层(0.213±0.061),肌层(0.1397±0.026),差异有统计学意义(P＜0.05);在封瘘组各层表达情况为:黏膜层(0.211±0.028),黏膜下层(0.119±0.022),肌层(0.097±0.007),差异有统计学意义(P＜0.05)。EGF在NEC组总体表达平均光密度值为(0.198±0.071),明显高于封瘘组(0.146±0.058),差异有统计学意义(P＜0.05)。结论 表皮生长因子(EGF)在新生儿坏死性小肠结肠炎(NEC)肠组织中的表达较封瘘组显著上调,推测EGF可能与NEC炎症相关,可能在NEC炎症过程中起到了一定的保护作用。

Objective We realized that EGF could play an important protective role against NEC. However, the practical condition of the distribution and expression of EGF in intestine of infants with NEC was indefinite. In order to figure out this problem,we carried out this experimentation. Methods The sample were divided into two group.The experimental group(necgroup) were composed of fifteen individual intestinal tissues after the ileostomy were performed on those infants suffered from NEC. The control group(sealing fistula group) were composed of fifteen individual intestinal tissues after the ileal closure fistula were performed on the same infants who were accepted the one-stage ileostomy in the period of NEC and were later accepted the two-stage operation on the condition that their bodies almost recovered from NEC after two to three months gone.Then, we utilized immunohistochemistry to test the distribution and quantities of EGF on those samples of the two group infants. Results The characteristic of EGF expression in intestine of the both group included strong positive expression in mucous layer and less expression in strata submucosum and muscular coat. The average optical density in nec group was mucous layer (0.241±0.075),strata submucosum(0.213±0.026),muscular coat (0.1397±0.022);In the control groupmucous layer (0.211±0.028),strata submucosum (0.119±0.022),muscular coat (0.097±0.007). The expression of EGF in intestinal tissues increased in the period of NEC0.198±0.071 by comparing with the control group (0.146±0.058). Conclusion There may be a correlation between the strong positive expression of EGF in intestinal tissues in the period of NEC and inflammation.By combining the result of this experiment and the research about EGF. We assumed that EGF is one factor of the protective mechanism by which injured intestinal mucous could be recovered and resist inflammation.