Parolini Filippo, Boroni Giovanni, Stefini Stefania, Agapiti Cristina, Bazzana Tullia, Alberti Daniele
Filippo Parolini, Giovanni Boroni, Daniele Alberti, Department of Pediatric Surgery, Azienda Ospedaliera Spedali Civili, 25123 Brescia, Italy.
World J Gastrointest Endosc. 2014 Oct 16;6(10):482-7. doi: 10.4253/wjge.v6.i10.482.
Preoperative tracheobronchoscopy (TBS) in the diagnostic assessment of newborns affected by esophageal atresia (EA) was described in 1981. Nevertheless, the value of the procedure is actually much debated; only a few studies have clearly explored the advantages of TBS and this procedure is not yet routinely included in the diagnostic and therapeutic assessment in many international pediatric surgery settings. Routine preoperative TBS is a safe procedure that enables the accurate examination of the tracheobronchial tree, the visualization of tracheoesophageal fistula and the diagnosis of tracheomalacia or associated respiratory anomalies. When a distal fistula is found, its occlusion with a Fogarty balloon catheter improves mechanical ventilation and facilitates surgical repair. This review provides a detailed overview on the use of TBS in newborns with EA, focusing on technical aspects, anesthesiological management, indications and limits. The benefits and risks of the procedure are also compared with alternative diagnostic tools, such as an esophageal contrast study, computed tomography scan and ultrasound.
1981年有关于术前气管支气管镜检查（TBS）在诊断评估食管闭锁（EA）新生儿中的描述。然而，该检查的价值目前仍存在很大争议；仅有少数研究明确探讨了TBS的优势，并且在许多国际小儿外科环境中，该检查尚未常规纳入诊断和治疗评估。常规术前TBS是一种安全的检查，能够准确检查气管支气管树，观察食管气管瘘，诊断气管软化或相关呼吸异常。当发现远端瘘时，用Fogarty球囊导管封堵可改善机械通气并便于手术修复。本综述详细概述了TBS在EA新生儿中的应用，重点关注技术方面、麻醉管理、适应证和局限性。该检查的益处和风险也与其他诊断工具进行了比较，如食管造影、计算机断层扫描和超声检查。
