探讨经右侧胸膜外径路Ⅰ期手术治疗Ⅲ型先天性食管闭锁(CEA)的疗效。

选择2014年1月至2017年12月，于昆明市儿童医院心胸外科接受右侧胸膜外径路Ⅰ期手术治疗的62例Ⅲ型CEA患儿为研究对象。采取回顾性分析方法，对其手术方法、术后吻合口狭窄与吻合口瘘发生情况及治疗结果进行分析，从而总结该术式的疗效、不良反应发生情况等。

本组62例Ⅲ型CEA患儿接受右侧胸膜外径路Ⅰ期手术治疗结果总结如下：①治疗有效率为87.7%(54/62)。②术后吻合口瘘发生率为11.3%(7/62)，术后吻合口狭窄发生率为11.3%(7/62)，总体不良反应发生率为22.6%(14/62)。③患儿放弃治疗率为6.5%(4/62)，病死率为6.5%(4/62)。④对治愈出院的54例患儿随访1～42个月的结果显示，均恢复良好。

本研究由于未进行随机对照试验，因此对于经右侧胸膜外径路Ⅰ期手术治疗Ⅲ型CEA的安全性和有效性，则尚需多中心、大样本随机对照试验进一步研究、证实。

To evaluate the effects of Ⅰ stage operation through the right external pleural approach in treatment of type Ⅲ congenital esophageal atresia (CEA).

From January 2014 to December 2017, a total of 62 newborns with type Ⅲ CEA who were treated by Ⅰ stage operation through the right external pleural approach in Kunming Children′s Hospital were included into this study as research subjects. The surgical methods, incidences of postoperative anastomotic stenosis and anastomotic leakage, treatment outcomes were analyzed by retrospective analysis method, so as to sum up the efficacy and adverse reactions of the operation.

The results of treatment for type Ⅲ CEA children through right external pleural approach in Ⅰ stage showed as following. ①The effective rate was 87.7% (54/62). ②Incidence of postoperative anastomotic leakage was 11.3% (7/62), incidence of postoperative anastomotic stenosis was 11.3% (7/62), and overall incidence of adverse reactions was 22.6% (14/62). ③The rate of abandoning treatment was 6.5% (4/62), and case fatality rate was 6.5% (4/62). ④After following-up of 1-42 months, the 54 cases who were discharged from hospital all recovered well.

Since the lack of control test in this study, the safety and effectiveness of Ⅰ stage operation through right external pleural approach for the treatment of type Ⅲ CEA still needs to be further studied and confirmed by a multicenter and large sample randomized controlled trial.