Ein Sigmund H, Palder Steven B, Filler Robert M
The Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
J Pediatr Surg. 2006 Mar;41(3):530-2. doi: 10.1016/j.jpedsurg.2005.11.061.
The purpose of this study was to review newborns with esophageal atresia (EA) with and without distal tracheoesophageal fistula (TEF) combined with duodenal atresia (DA) or duodenal stenosis (DS) (web, windsock, diaphragm) to determine which clinical features and treatments give the best results.
Twenty-four newborns were reviewed from 1971 to 2000 inclusive. Seven had EA and 17 had EA with TEF; 15 had DA and 9 had DS. One died after receiving only a gastrostomy. Seven underwent repair of both defects in 1 stage, whereas 16 were repaired separately.
Eighteen of 24 (75%) survived. The EA or EA with TEF was repaired first in 5, but the DA or DS was initially overlooked in 4 and 2 died. The DA or DS was repaired first in 11, and all survived. Of the 7 in whom both repairs were done at same setting, 4 survived. Of 6 nonsurvivors, 5 were repaired. Mortality from EA was greater than EA with TEF, and DA was greater than DS. Associated anomalies in 18 (75%) of 24 did not affect survival.
Staged repair (ideally within 1 week) is a safe suitable method of management. In EA, the coexistence of DA or DS must be considered because delay in diagnosis may adversely affect outcome. Mortality is a multifactorial phenomenon.
本研究旨在回顾患有食管闭锁（EA）伴或不伴远端气管食管瘘（TEF）合并十二指肠闭锁（DA）或十二指肠狭窄（DS）（蹼、风袋、隔膜）的新生儿，以确定哪些临床特征和治疗方法能带来最佳结果。
回顾了1971年至2000年（含）期间的24例新生儿。7例患有EA，17例患有EA合并TEF；15例患有DA，9例患有DS。1例仅接受胃造口术后死亡。7例在一期修复了两种缺陷，而16例是分别修复的。
24例中有18例（75%）存活。5例先修复了EA或EA合并TEF，但4例最初忽视了DA或DS，2例死亡。11例先修复了DA或DS，全部存活。在7例同时进行两种修复的患儿中，4例存活。6例非存活者中，5例接受了修复。EA的死亡率高于EA合并TEF，DA的死亡率高于DS。24例中有18例（75%）的相关畸形不影响存活。
分期修复（理想情况下在1周内）是一种安全合适的治疗方法。对于EA，必须考虑DA或DS的共存，因为诊断延迟可能会对预后产生不利影响。死亡率是一个多因素现象。
