Ng J, Antao B, Bartram J, Raghavan A, Shawis R
Pediatric Surgical Unit and Department of Radiology, Sheffield Children's Hospital, Western Bank, Sheffield, UK.
Acta Radiol. 2006 Oct;47(8):801-5. doi: 10.1080/02841850600854902.
To evaluate the diagnostic difficulties and pitfalls in establishing the diagnosis of congenital H-type tracheoesophageal fistula.
A retrospective review of all cases of H-type tracheoesophageal fistula that were diagnosed in a single unit over a 6-year period. The variables assessed were age at presentation, presenting symptoms, time to diagnosis, investigations, and time to surgical repair of H-type fistula. The investigations leading to a definitive diagnosis are assessed and discussed.
Between 1998 and 2004, five cases of H-type tracheoesophageal fistula presented to our unit. All cases had an upper gastrointestinal contrast study/tube esophagogram. In addition, four cases had a chest radiograph, three cases had a bronchoscopy, and one case an esophagoscopy. The median delay from the time of first presentation to diagnosis of H-type tracheoesophageal fistula was 14 days (7-58 days). Median age at surgery was 15 days (8-60 days).
Although symptoms are usually present from birth, the diagnosis of H-type fistula is difficult and often delayed. The various diagnostic techniques are not entirely reliable and fistula identification can be elusive. The authors present recommendations for the diagnostic work-up, which may increase the diagnostic potential and avoid unnecessary delays in the diagnosis and management of H fistula.
评估先天性H型气管食管瘘诊断过程中的困难与陷阱。
回顾性分析某一科室在6年期间诊断的所有H型气管食管瘘病例。评估的变量包括就诊年龄、临床表现、诊断时间、检查方法以及H型瘘管的手术修复时间。对最终确诊的检查方法进行评估和讨论。
1998年至2004年期间，有5例H型气管食管瘘病例在本单位就诊。所有病例均进行了上消化道造影/食管导管造影。此外，4例进行了胸部X线检查，3例进行了支气管镜检查，1例进行了食管镜检查。从首次就诊到诊断为H型气管食管瘘的中位延迟时间为14天（7 - 58天）。手术时的中位年龄为15天（8 - 60天）。
尽管症状通常自出生时就存在，但H型瘘管的诊断困难且常被延迟。各种诊断技术并非完全可靠，瘘管的识别可能难以捉摸。作者提出了诊断检查的建议，这可能会提高诊断的可能性，并避免在H型瘘管的诊断和治疗中出现不必要的延迟。
