Zhang Minzhong,8,Yu Juming,et al.Multidisciplinary framework for standardized management of recurrent tracheoesophageal fistula after operations for esophageal atresia[J].Journal of Clinical Pediatric Surgery,,20():1108-1115.[doi:10.12260/lcxewkzz.2021.12.002]
Multidisciplinary framework for standardized management of recurrent tracheoesophageal fistula after operations for esophageal atresia
- Keywords:
- Esophageal Atresia/CN; Postoperative Complications/SU; Postoperative Complications/TH; Recurrent Tracheoesophageal FistulaTracheoesophageal Fistula; Multidisciplinary Team; Treatment Outcome
- CLC:
- R571;R726.1
- Abstract:
- Objective As one complex complication after repairing esophageal atresia, recurrent tracheoesophageal fistula (rTEF) requires therapeutic interventions with multiple specialized professionals.A multidisciplinary team (MDT) has been formed for managing rTEF children in recent years.The goal of this study was to summarize clinical experiences and evaluate prognostic outcomes of rTEF management at our center.Methods Retrospective review was conducted for clinical data and postoperative follow-up results of 164 rTEF inpatients from September 2012 to December 2020.MDT members included professionals from general pediatric surgery, pediatric respiratory medicine, pediatric intensive care unit, ear-nose-throat (ENT), interventional radiology and pediatric healthcare.Standardized treatment protocols were formulated for preoperative evaluations, perioperative interventions and postoperative follow-ups.Results The initial surgery for esophageal atresia was thoracoscopic repair (n=115, 70.1%).Preoperative examinations revealed asymptomatic tracheomalacia (n=33), vocal fold immobility (n=21) and laryngomalacia (n=6).A total of 191 operations were performed.The incidence of postoperative anastomotic leak, anastomotic stricture and recurrence was 27.4%, 21.3% and 9.1% respectively.The overall mortality rate was 3.7%.Nineteen survivals experienced difficult postoperative weaning from mechanical ventilation.Among 9 cases of tracheomalacia, 8 children were cured by conservative measures.Otolaryngology revealed laryngomalacia (n=3).One child was cured by supraglottoplasty while another two were relieved after conservative measures.Granulation formation in airway was identified under laryngoscopy (n=7) and all were cured by endoscopy.An obvious declining tendency in postoperative complications, duration of stay, duration of stay in pediatric intensive care unit and total stay of hospitalization were recorded.Mid-term follow-ups (a median of 33.6 months) hinted at pathological gastroesophageal reflux (n=29) and 6 recovered after fundoplication.None of the survivors had any severe respiratory complication.Conclusion MDT approach may foster a proper coordination of various specialties to offer benefits to the management of rTEF, lower postoperative comorbidities and improve patient prognoses.
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Memo
收稿日期:2021-07-21。
基金项目:1.申康临床三年行动计划疑难疾病诊治攻关项目（编号：SHDC2020CR2063B）；2.上海市科委科技创新行动计划生物医药领域科技支撑项目（编号：19441905500）；3.上海市青年科技英才扬帆计划（编号：19YF1432000）；4.上海市科委科技创新行动计划医学引导类科技支撑项目（编号：19411968900）；5.上海市转化医学协同创新中心项目（编号：TM201910）
通讯作者:王俊,Email:jwangjl@126.com