Bax Klaas N M A, Roskott Anne Margot C, van der Zee David C
Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands.
J Pediatr Surg. 2008 Mar;43(3):522-5. doi: 10.1016/j.jpedsurg.2007.10.034.
This retrospective study was performed to test our suspicion that the incidence of esophageal atresia with proximal fistula in our institution is much higher than is generally reported.
The charts of all patients with esophageal atresia and/or tracheoesophageal fistula admitted in the period 1982 to 2000 were analyzed. The type of atresia and/or tracheoesophageal fistula was noted, and the relative incidence was calculated and compared with the relative incidence in a cumulative series of 3492 patients taken from 9 published studies.
In the period under study, 123 patients with esophageal atresia and/or tracheoesophageal fistula were identified. The relative incidence of esophageal atresia without distal fistula was statistically not different (10.6% in the present series against 8.49% in the reference group). A statistically significant difference in the relative incidence of esophageal atresia with proximal fistula, however, was found: 5.69% in the present series against 1.05% in the reference group (P < .0001). Looking at the subgroup of patients without a distal fistula, more than half of the patients did have a proximal fistula.
The relative incidence of esophageal atresia with proximal fistula in this series of children with esophageal atresia and/or tracheoesophageal fistula is significantly higher than reported in the literature. This is on the account of the subgroup of patients without a distal fistula in which the incidence of a proximal fistula is more than 50%. Especially in this subgroup, the existence of a proximal fistula should be ruled out preoperatively.
本回顾性研究旨在验证我们的怀疑，即我院食管闭锁合并近端瘘的发生率远高于一般报道。
分析了1982年至2000年期间收治的所有食管闭锁和/或气管食管瘘患者的病历。记录闭锁和/或气管食管瘘的类型，计算相对发生率，并与9项已发表研究中3492例患者的累积系列中的相对发生率进行比较。
在研究期间，共确定了123例食管闭锁和/或气管食管瘘患者。无远端瘘的食管闭锁相对发生率在统计学上无差异（本系列为10.6%，参考组为8.49%）。然而，食管闭锁合并近端瘘的相对发生率存在统计学显著差异：本系列为5.69%，参考组为1.05%（P <.0001）。在无远端瘘的患者亚组中，超过一半的患者有近端瘘。
在这一系列食管闭锁和/或气管食管瘘患儿中，食管闭锁合并近端瘘的相对发生率显著高于文献报道。这是由于无远端瘘的患者亚组中近端瘘的发生率超过50%。特别是在这个亚组中，术前应排除近端瘘的存在。
