Section of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI 48109-0245, USA.
J Pediatr Surg. 2010 Feb;45(2):337-40. doi: 10.1016/j.jpedsurg.2009.10.070.
This review provides a blueprint to deal with the diagnosis and management of recurrent tracheoesophageal fistulas.
A retrospective review over 27 years found 26 recurrent tracheoesophageal fistulas. Descriptive statistical analyses were performed.
In this cohort of 26 patients, 18 had a leak after their primary operation; and 22 had respiratory symptoms leading to the discovery of the recurrent fistula. The diagnosis was made by contrast study in 24. The repairs entailed placing a catheter through the fistula; separating the trachea and esophagus using sharp dissection; and placing tissue, preferably pericardium, between the suture lines. Postoperative complications included 7 anastamotic leaks, 4 strictures, and 3 recurrent fistulas. Long-term follow-up (median of 84 months) showed that 21 took all of their nutrition by mouth, 3 were tube fed, and 2 required a combination. Of the 23 patients with growth chart data, 16 fell in the first quartile of the growth chart, whereas none fell between the 75th and 100th percentile.
This series, the largest to date, describes characteristics of recurrent tracheoesophageal fistulas, including techniques to make the diagnosis and provide a secure closure of the fistula, and the long-term outcomes of these patients.
本文提供了一份处理复发性气管食管瘘的诊断和管理的蓝图。
通过回顾性分析，我们在 27 年的时间里发现了 26 例复发性气管食管瘘患者。对这些患者的数据进行了描述性统计分析。
在这组 26 例患者中，18 例在初次手术后发生瘘管；22 例有呼吸道症状导致复发性瘘管的发现。24 例通过对比研究做出诊断。修复方法包括通过瘘管放置导管；使用锐性分离使气管和食管分离；以及在缝线之间放置组织，最好是心包组织。术后并发症包括 7 例吻合口漏、4 例狭窄和 3 例复发性瘘管。长期随访（中位数为 84 个月）显示，21 例患者全部经口摄入营养，3 例患者经鼻饲管喂养，2 例患者需要联合治疗。在有生长图表数据的 23 例患者中，16 例的生长图表数据位于第 1 个四分位数，而没有患者的数据位于第 75 百分位至第 100 百分位之间。
这是迄今为止最大的一组复发性气管食管瘘患者，描述了其特征，包括做出诊断和安全闭合瘘管的技术，以及这些患者的长期预后。
