Nagatani Atsuko, Shibata Shigeki, Hashiguchi Hideo, Tsuda Atsushi, Nagaoka Kyoko, Tagawa Masato
Department of Anesthesia, Nagasaki Medical Center, Nagasaki 856-8562.
Masui. 2002 Aug;51(8):913-5.
Laryngotracheoesophageal cleft (LTEC) is an extremely rare congenital anomaly characterized by an absence of all or a part of the tracheoesophageal septum producing an abnormal communication between the trachea and esophagus, and is often difficult to be diagnosed. A 2-day-old male baby was tentatively diagnosed as tracheoesophageal fistula type Gross C, and underwent gastrostomy. The trachea was intubated before anesthetic induction. When a balloon of gastrostomy catheter was inflated, the lung could not be ventilated. After extubation of endotracheal tube and removal of gastrostomy catheter, the lung could be ventilated with mask. When endotracheal tube was intubated again, the lung could not be ventilated at all. Thus the surgery was performed under mask ventilation. Endoscopic examination performed 2 weeks later gave diagnosis of LTEC type 3. It is likely that the endotracheal tube might have been advanced into the end of the esophagus due to absence of the tracheoesophageal septum. In spite of a rare disease, LTEC should be considered as an extreme case of transesophageal fistula with a high risk of difficult airway.
喉气管食管裂（LTEC）是一种极其罕见的先天性畸形，其特征是气管食管隔全部或部分缺失，导致气管与食管之间出现异常通道，且常难以诊断。一名2日龄男婴初步诊断为粗大C型气管食管瘘，并接受了胃造口术。麻醉诱导前对气管进行了插管。当胃造口导管的气囊充气时，肺部无法通气。拔出气管内导管并移除胃造口导管后，使用面罩可使肺部通气。再次插入气管内导管时，肺部完全无法通气。因此，手术在面罩通气下进行。2周后进行的内镜检查诊断为3型LTEC。由于气管食管隔缺失，气管内导管很可能已进入食管末端。尽管LTEC是一种罕见疾病，但应将其视为经食管瘘的极端情况，存在气道困难的高风险。
