Huang Hua,Ma Shaobin,Chen Xuanxuan,et al.Analysis of managing type Ⅴ congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,2025,(06):577-581.[doi:10.3760/cma.j.cn101785-202410015-013]
Analysis of managing type Ⅴ congenital esophageal atresia
- Keywords:
- Esophageal Atresia; Congenital; Surgical Procedures; Operative; Thoracic Surgery; Video-Assisted; Thoracoscopes; Flexible Bronchoscope; Treatment Outcome; Postoperative Complications
- Abstract:
- Objective To summarize the clinical diagnosis and treatment experience of congenital esophageal atresia type V (V-CEA). Methods A retrospective analysis was performed for the relevant clinical data of 8 V-CEA children admitted into Third Affiliated Hospital of Zhengzhou University from September 2020 to June 2024.General data (gender,age,weight,clinical manifestations & auxiliary examinations),as well as surgical and prognostic data (age at surgery,surgical approach,fistula location,complications,reoperation & prognosis) were retrospectively reviewed. Results Eight children were hospitalized for postnatal choking cough,dyspnea and vomiting.There were 3 boys and 5 girls.The age range was ≤ 28 day (n=4),29 day to 1 year (n=3) and ≥ 1 year (n=1).Weight ranged from 1.9 to 11 kg.Ⅴ-CEA was detected by preoperative esophageal radiography (n=4),chest CT 3D reconstruction (n=2) and fiberoptic bronchoscopy (n=8).Fistulas were located at the 2nd thoracic vertebra (n=5),between C7 and T1 (n=2) and between T2 and T3 (n=1).Within 4-24 days of admission,transthoracic (n=6) and left cervical (n=2) approaches were employed.The procedures included thoracoscopic plus fiberoptic bronchoscopy (double-mirror,n=4),conversion from double-mirror into thoracotomy (n=1),thoracotomy plus fiberoptic bronchoscopy (n=1) and cervical approach plus fiberoptic bronchoscopy (n=2).Postoperatively,2 cases developed hoarseness with dysphagia.Multiple esophageal radiographies and bronchoscopies showed no anastomotic fistula or recurrence.During follow-ups of (1-18) month,one recurrent case each at Month 3/4 was reoperated.Two cases of mild choking cough gradually resolved after 18 months and the remainders had no obvious complications. Conclusions During thoracoscopy or open surgery,combining fiberoptic bronchoscopy is both safe and feasible for localizing and repairing Ⅴ-CEA fistula.It can quickly and accurately localize fistula,lower operative difficulties and shorten operative duration.During operation,ligating and dividing fistula and repairing fistula at tracheal and esophageal sides may effectively reduce the postoperative recurrence of fistula.
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Memo
收稿日期:2024-10-9。
通讯作者:黄华,Email:hhuang0989@163.com