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,2025,(10):952-956.[doi:10.3760/cma.j.cn101785-202502044-009]
Ⅲ型先天性食管闭锁手术后食管气管瘘复发的诊治分析
- Title:
- 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
- 摘要:
- 目的 探讨先天性食管闭锁手术后食管气管瘘复发(recurrent tracheoesophageal fistula,rTEF)的术前诊断方法,并评估术中经气管插管加压通气确认瘘管位置的可行性。方法 回顾性分析2010年1月至2024年6月在中南大学湘雅医学院附属儿童医院(湖南省儿童医院)新生儿外科诊断并治疗的Ⅲ型先天性食管闭锁手术后rTEF患儿临床资料。术前诊断方法包括口服食管造影及改良食管造影,术中采取气管插管加压通气明确复发瘘管的位置。收集所有患儿临床表现、诊断及再手术情况。结果 共纳入8例患儿,其中6例主要表现为咳嗽及反复肺炎(1例以夜间咳嗽为主),1例为吃奶呛咳,1例为呼吸机辅助通气下出现明显腹胀,症状持续时间410(9,3102)d。2例术前采取口服食管造影检查,分别经过6次和7次造影检查后确诊为rTEF;6例术前采用改良食管造影方式,均1次确诊。再次手术时年龄为365(41,3 285)d,手术时体重8.8(3.9,25.2)kg。患儿均于胸腔镜下经右侧胸腔行瘘管切除术,术中经气管插管加压通气确认复发瘘管位置,手术时间182(100,300)min。术后1例出现食管吻合口瘘,经保守治疗后痊愈;1例再次复发,经胃镜下食管黏膜夹闭后再次复发,住院期间死于呼吸衰竭;其余7例术后均无食管狭窄无需食管扩张。结论 改良食管造影方法能快速有效诊断先天性食管闭锁手术后rTEF,术中通过气管插管加压通气辨认、定位瘘管是一种快速、简单及有效的方法,可缩短手术时间及减少手术创伤。
- 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.
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备注/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