Gu Yichao,Hua Kaiyun,Liao Junmin,et al.Management strategies for corrosive tracheoesophageal fistula and concurrent esophageal stricture in children[J].Journal of Clinical Pediatric Surgery,2026,(04):382-386.[doi:10.3760/cma.j.cn101785-202503105]
儿童腐蚀性气管食管瘘及合并食管狭窄诊治探讨
- Title:
- Management strategies for corrosive tracheoesophageal fistula and concurrent esophageal stricture in children
- Keywords:
- Corrosive Tracheoesophageal Fistula; Button Battery; Esophageal Stricture; Esophageal Dilation
- 摘要:
- 目的 探讨儿童腐蚀性气管食管瘘(tracheoesophageal fistula,TEF)及合并食管狭窄的诊治策略和疗效。方法 本研究为回顾性病例系列研究,收集2018年10月至2024年10月首都医科大学附属北京儿童医院收治的10例腐蚀性TEF患儿临床资料,男4例、女6例,7例为纽扣电池导致,3例为非纽扣电池导致。6例合并食管狭窄。收集患儿临床资料、摄入腐蚀性物质类型、并发症、治疗方式及预后情况。结果 7例纽扣电池所致TEF患儿中,3例经保守治疗瘘口自行愈合,中位自愈时间为3个月(2~4个月),4例接受手术治疗。3例非纽扣电池导致TEF患儿接受手术治疗。7例手术患儿中位手术时间为受伤后12(5~24)个月。10例TEF患儿中,6例合并食管狭窄,其中1例食管狭窄严重,在TEF愈合前行食管扩张;5例未行扩张。4例食管狭窄在TEF愈合后平均2.6个月开始食管扩张治疗,中位扩张次数14次。随访结果显示,8例患儿生长发育良好,1例体重增长不佳,1例仍存在TEF,留置空肠喂养管喂养。结论 纽扣电池所致儿童腐蚀性TEF存在自愈可能,可首先选择保守治疗,如受伤后6个月仍未愈合则行手术治疗。若合并食管狭窄,待TEF愈合后再行扩张治疗是安全有效的策略。
- Abstract:
- Objective To explore the management strategies and outcomes of corrosive tracheoesophageal fistula (TEF) with or without esophageal stricture in children.Methods For this retrospective case series,the relevant clinical data were retrospectively reviewed for 10 hospitalized children of corrosive TEF between October 2018 and October 2024.There were 4 boys and 6 girls.The causes were button batteries (n=7) and non-button battery corrosive agents (n=3).Six of them were complicated with esophageal stricture.Clinical profiles,type of ingested corrosive substances,complications,therapeutic strategies and clinical outcomes were recorded.Results Among 7 cases of button battery-induced TEF,3 achieved spontaneous closure with conservative measures with a median healing time of 3(2-4) month while 4 were surgically repaired.Three cases of non-button battery-induced TEF were operated with a median time to surgery of 12(5-24) month post-injury.Six cases developed concomitant esophageal stricture.One case of severe stricture underwent esophageal dilation before fistula healing while the remainders underwent no pre-healing dilation.After fistula closure,4 cases started esophageal dilation at a mean of 2.6 months with a median of 14 dilation sessions.During follow-ups,there were normal growth & development (n=8),poor weight gain (n=1) and persistent TEF requiring jejunal feeding (n=1).Conclusions Button battery-induced corrosive TEF in children offers the potential for spontaneous closure.Conservative management may be considered as an initial approach.Surgical intervention is recommended if fistula fails to heal within 6 months post-injury.For children with concomitant esophageal stricture,initiating dilation after fistula closure proves safe and effective.
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备注/Memo
收稿日期:2025-3-28。
基金项目:北京高层次创新创业领军人才计划(20250058); 北京市科学技术委员会自主项目(Z211100002921062)
通讯作者:黄金狮,Email:jsdr2002@126.com