Wang Junjie,He Qiuming,Zhong Wei,et al.Programmed management of H-type congenital tracheoesophageal fistula[J].Journal of Clinical Pediatric Surgery,2023,22(04):340-344.[doi:10.3760/cma.j.cn101785-202303015-008]
H型先天性食管气管瘘的程序化诊治
- Title:
- Programmed management of H-type congenital tracheoesophageal fistula
- Keywords:
- Esophageal Atresia; Tracheoesophageal Fistula; Diagnosis; Surgical Procedures; Operative; Treatment Outcome
- 摘要:
- 目的 总结程序化诊治H型先天性食管气管瘘(H-type tracheoesophageal fistula,H-TEF)的临床效果。方法 回顾性分析2017年3月至2022年3月广州市妇女儿童医疗中心新生儿外科收治的10例采取程序化诊治的H-TEF患儿临床资料。其中新生儿6例,主要表现为反复出现喂养后呛咳;婴幼儿4例,主要表现反复发生肺炎。合并先天性心脏病1例,胸椎半椎体畸形1例。程序化诊治流程:经食管造影和(或)纤维支气管镜检查明确诊断后置入鼻胃管喂养;待炎症指标正常或接近正常,X线胸片肺部无炎性改变后,于术前纤维支气管镜引导下在食管气管瘘管内留置导管;经床边X线检查确认瘘管位置,如瘘管位于第2胸椎水平以上则采取经颈部手术、位于第2胸椎水平以下则采取经胸腔镜手术。结果 10例中,经食管造影确诊7例,经纤维支气管镜确诊3例。患儿术前均成功放置食管气管瘘管内导管。7例瘘管位于第2胸椎水平以上,采取经右颈开放下食管气管瘘修补术;3例瘘管位于第2胸椎水平以下,采取胸腔镜手术。均于术后次日即经鼻胃管喂养,术后1周予食管造影检查,无一例出现吻合口漏或食管气管瘘复发。随访8个月至5年,3例经颈部开放手术患儿出现声音嘶哑,于术后1~6个月恢复;无一例出现吞咽困难、食管气管瘘复发表现。结论 程序化诊治H-TEF可获得满意的临床疗效,为H-TEF的管理提供了一种整体化思路。
- Abstract:
- Objective To summarize the clinical efficacy of programmed management for H-type congenital tracheoesophageal fistula (H-TEF).Methods From March 2017 to March 2022,clinical data were retrospectively reviewed for 10 H-TEF children under programmed management.Six neonates developed recurrent cough after feeding and 4 infants had recurrent pneumonia.One case was associated with congenital heart disease and another had hemivertebra deformity of thoracic vertebra.After a definite diagnosis was confirmed by esophagography and/or fiberbronchoscope,gastric tube feeding was initiated.After inflammatory parameters normalized completely or partially and pneumonic change disappeared on chest film,a catheter was placed in fistula under a guidance of fiberbronchoscope.The position of fistula was confirmed by bedside radiography;H-TEF was repair through a cervical approach when fistula was located above T2 level and thoracoscopically below T2.Results Seven cases were confirmed by esophagography and 3 cases by fiberbronchoscope.Catheter was successfully deployed in fistula in all cases before surgery.Seven cases of fistula above T2 were repaired through a right cervical route and 3 cases of fistula below T2 underwent thoracoscopy.Feeding through a gastric tube resumed the next day and esophagography 1 week later.There was no leakage or recurrence during a follow-up period of (8-60) month.Three cases of hoarseness occurred after cervical surgery and recovered at (1-6) month.No dysphagia or recurrence was noted.Conclusion An integrated strategy for H-TEF yields satisfactory outcomes under programmed management.
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备注/Memo
收稿日期:2023-3-5。
基金项目:广东省科技计划项目(2014A020212022);广州市基础研究计划基础与应用基础研究项目(202102080511)
通讯作者:何秋明,Email:qiuminghe@foxmail.com