Li Bo,Dong Jie,Zhao Fan,et al.Diagnosis and treatment of recurrent tracheoesophageal fistula after surgery for type Ⅲ congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,,():952-956.[doi:10.3760/cma.j.cn101785-202502044-009]
Diagnosis and treatment of recurrent tracheoesophageal fistula after surgery for type Ⅲ congenital esophageal atresia
- Keywords:
- Esophageal Atresia; Surgical Procedures; Operative; Esophageal Angiography; Recurrence; Esophageal-tracheal Fistula
- Abstract:
- Objective To explore the preoperative diagnostic modalities for recurrent tracheoesophageal fistula (rTEF) after type Ⅲ congenital esophageal atresia repairing and evaluate the feasibility of intraoperative identification of fistula location via pressurized ventilation through a tracheal tube. Methods A retrospective analysis was conducted for medical records of 8 children diagnosed and treated for type Ⅲ esophageal atresia with rTEF from 2010 to 2024.Preoperative diagnostic modalities included oral esophagography and modified esophagography.Intraoperative identification of recurrent fistula location was achieved through pressurized ventilation via a tracheal tube. Results Among them,6 cases primarily exhibited clinical symptoms of cough and recurrent pneumonia,one child derloped noctural cough.There were choking during feeding (n=1) and significant abdominal distension under ventilator-assisted ventilation (n=1).The latter had a duration of symptoms of 410(9,3102) day.Two cases were confirmed as rTEF using oral esophageal contrast imaging,requiring 6 and 7 imaging sessions respectively.The remainders were diagnosed with a single session of modified esophageal contrast imaging.Reoperative age was 365(41,3285) day with a surgical weight of 8.8(3.9,25.2) kg.Thoracoscopic fistula resection was performed via right thoracic cavity.And intraoperative pressurized ventilation through tracheal tube quickly confirmed the location of recurrent fistula.Surgical duration was 182(100,300) min.Postoperatively,one case (12%) of esophageal anastomotic fistula healed with conservative measures.Another child (12%) experienced a recurrence of rTEF after endoscopic esophageal mucosal clipping and resulted in death from respiratory failure during hospitalization.The remainders required no esophageal dilation for postoperative esophageal stenosis. Conclusions Modified esophageal contrast imaging is both rapid and effective for diagnosing rTEF.Intraoperative identification and localization of fistula through pressurized ventilation via a tracheal tube is a quick,simple and effective approach shortening duration of surgery and minimizing trauma.
References:
[1] Koivusalo A,Mutanen A,Suominen J,et al.Distal recurrent tracheoesophageal fistula after repair of esophageal atresia-incidence,risk factors,and outcome[J].Eur J Pediatr Surg,2023,33(1):68-73.DOI:10.1055/s-0042-1758154.
[2] Yang S,Li SQ,Yang Z,et al.Risk factors for recurrent tracheoesophageal fistula after gross type C esophageal atresia repair[J].Front Pediatr,2021,9:645511.DOI:10.3389/fped.2021.645511.
[3] 中华医学会小儿外科分会新生儿外科学组,中华医学会小儿外科分会普胸外科学组.食管闭锁术后食管气管瘘复发诊疗的专家共识(2023)[J].中华小儿外科杂志,2024,45(1):10-19.DOI:10.3760/cma.j.cn421158-20231120-00508. Groups of Neonatal Surgery and General Thoracic Surgery,Branch of Pediatric Surgery,Chinese Medical Association.Expert Consensus on Diagnosing and Treating Recurrent Esophagotracheal Fistula after Esophageal Atresia Surgery (Edition 2023)[J].Chin J Pediatr Surg,2024,45(1):10-19.DOI:10.3760/cma.j.cn421158-20231120-00508.
[4] Bruch SW,Hirschl RB,Coran AG.The diagnosis and management of recurrent tracheoesophageal fistulas[J].J Pediatr Surg,2010,45(2):337-340.DOI:10.1016/j.jpedsurg.2009.10.070.
[5] Singh VK,Raman VS,Taleja H,et al.Recurrent tracheo-esophageal fistula-management challenges:case report and review of current literature[J].Med J Armed Forces India,2023,79(Suppl 1):S311-S314.DOI:10.1016/j.mjafi.2022.01.007.
[6] Guo WH,Li YZ,Jiao AX,et al.Tracheoesophageal fistula after primary repair of type C esophageal atresia in the neonatal period:recurrent or missed second congenital fistula[J].J Pediatr Surg,2010,45(12):2351-2355.DOI:10.1016/j.jpedsurg.2010.08.030.
[7] Rakoczy G,Brown B,Barman D,et al.KTP laser:an important tool in refractory recurrent tracheo-esophageal fistula in children[J].Int J Pediatr Otorhinolaryngol,2010,74(3):326-327.DOI:10.1016/j.ijporl.2009.12.009.
[8] Zhu HT,Shen C,Xiao XM,et al.Reoperation for anastomotic complications of esophageal atresia and tracheoesophageal fistula[J].J Pediatr Surg,2015,50(12):2012-2015.DOI:10.1016/j.jpedsurg.2015.08.015.
[9] Nazir Z,Khan MAM,Qamar J.Recurrent and acquired tracheoesophageal fistulae (TEF)-minimally invasive management[J].J Pediatr Surg,2017,52(10):1688-1690.DOI:10.1016/j.jpedsurg.2017.03.048.
[10] Wang J,Zhang M,Pan W,et al.Management of recurrent tracheoesophageal fistula after esophageal atresia and follow-up[J].Dis Esophagus,2017,30(9):1-8.DOI:10.1093/dote/dox081.
[11] Zhang MZ,Lin YW,Xie W,et al.The multidisciplinary management of recurrent tracheoesophageal fistula after esophageal atresia:experience with 135 cases from a tertiary center[J].J Pediatr Surg,2021,56(11):1918-1925.DOI:10.1016/j.jpedsurg.2020.12.019.
[12] Hua KY,Yang S,Zhang YN,et al.Thoracoscopic surgery for recurrent tracheoesophageal fistula after esophageal atresia repair[J].Dis Esophagus,2020,33(9):doaa023.DOI:10.1093/dote/doaa023.
[13] Briganti V,Coletta R,Giannino G,et al.Usefulness of dextranomer/hyaluronic acid copolymer in bronchoscopic treatment of recurrent tracheoesophageal fistula in children[J].Int J Pediatr Otorhinolaryngol,2011,75(9):1191-1194.DOI:10.1016/j.ijporl.2011.06.018.
[14] Schlesinger AE,Mazziotti MV,Cassady CI,et al.Recurrent tracheoesophageal fistula after thoracoscopic repair:vanishing clips as a potential sign[J].Pediatr Surg Int,2011,27(12):1357-1359.DOI:10.1007/s00383-011-2902-8.
[15] Lelonge Y,Varlet F,Varela P,et al.Chemocauterization with trichloroacetic acid in congenital and recurrent tracheoesophageal fistula:a minimally invasive treatment[J].Surg Endosc,2016,30(4):1662-1666.DOI:10.1007/s00464-015-4352-1.
[16] Gregory S,Chun RH,Parakininkas D,et al.Endoscopic esophageal and tracheal cauterization for closure of recurrent tracheoesophageal fistula:a case report and review of the literature[J].Int J Pediatr Otorhinolaryngol,2017,98:158-161.DOI:10.1016/j.ijporl.2017.04.051.
[17] Cano Novillo I,Aneiros Castro B,Godoy Lenz J,et al.Thoracoscopic approach for complications after esophageal atresia repair:initial experience[J].Asian J Endosc Surg,2020,13(2):147-151.DOI:10.1111/ases.12714.
[18] Kamran A,Zendejas B,Meisner J,et al.Effect of posterior tracheopexy on risk of recurrence in children after recurrent tracheo-esophageal fistula repair[J].J Am Coll Surg,2021,232(5):690-698.DOI:10.1016/j.jamcollsurg.2021.01.011.
[19] 华凯云,赵勇,谷一超,等.胸腔镜下食管闭锁修补术后食管气管瘘复发18例[J].中华小儿外科杂志,2019,40(6):499-502.DOI:10.3760/cma.j.issn.0253-3006.2019.06.004. Hua KY,Zhao Y,Gu YC,et al.Thoracoscopic repair of recurrent tracheoesophageal fistula after operation for esophageal atresia:a report of 18 cases[J].Chin J Pediatr Surg,2019,40(6):499-502.DOI:10.3760/cma.j.issn.0253-3006.2019.06.004.
[20] 何秋明,王哲,钟微,等.食管闭锁术后发生食管气管瘘复发患儿的程序化治疗[J].中华小儿外科杂志,2020,41(12):1078-1083.DOI:10.3760/cma.j.cn421158-20200326-00200. He QM,Wang Z,Zhong W,et al.Programmed management of recurrent tracheoesophageal fistula[J].Chin J Pediatr Surg,2020,41(12):1078-1083.DOI:10.3760/cma.j.cn421158-20200326-00200.
[21] Patkowski D,Toczewski K,Ergun E.Novel left-sided thoracoscopic approach to recurrent tracheoesophageal fistula and post-fistula tracheal diverticula[J].J Clin Med,2023,12(23):7251.DOI:10.3390/jcm12237251.
Memo
收稿日期:2025-2-23。
基金项目:湖南省卫生健康委员会科研计划项目(D202306028536); 湖南省卫健委课题(202206024760)
通讯作者:周崇高,Email:zhouchonggao@sina.com