Yalcin Sule, Demir Numan, Serel Selen, Soyer Tutku, Tanyel F Cahit
Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
J Pediatr Surg. 2015 Nov;50(11):1823-7. doi: 10.1016/j.jpedsurg.2015.07.002. Epub 2015 Jul 3.
A retrospective study was performed to evaluate the functional disorders of deglutition with videofluoroscopy (VFS), in children operated for esophageal atresia (EA) and/or tracheoesophageal fistula (TEF).
Patients with the repair of EA-TEF were evaluated in respect to the type of malformation, operative procedure, postoperative complications, deglutitive and respiratory symptoms, and gastroesophageal reflux disease (GERD). The dysphagia score, VFS findings of oral, pharyngeal and esophageal phases, and penetration-aspiration scale (PAS) score were recorded in the evaluation of the deglutitive functions.
Thirty-two cases with a median age of 48months (2-120months), and male to female ratio of 14:18 were included in the study. Most of the cases had Gross type C anomaly (n=26, 81.3%), and the others were type A (n=3), D (n=2) and E (n=1). The incidence of associated anomalies was 71.8%. The patients underwent primary (n=26, 81.3%) or delayed (n=6, 18.7%) anastomosis. Postoperative complications including anastomotic stricture (n=12), leak (n=2) and recurrent fistula (n=2) were managed by dilatation, conservative approach and repair of the fistula, respectively. Recurrent pneumonia (n=13), cough with liquid intake (n=10) and food impaction (n=7) were recorded in the history. Management of GERD included medical (n=11) and surgical (n=7) treatment. The median dysphagia score was 3.5 (min: 0-max: 27). The oral phase of VFS was normal in most of the cases (n=29, 90.6%). Only three had mild or moderate impairment, and none had severe. The pharyngeal phase showed no impairment in 23 of the cases (71.8%), and severe impairment was observed only in 3 of all, for the parameters of hyolaryngeal elevation and airway closure. Opposite to the first two phases of the deglutition, the esophageal phase was normal in only 2 of the cases (6.3%). Among the other 30 cases with impairment, only two had mild, and the rest had moderate to severe problems. Esophageal backflow, motility and residue were the most severely impaired parameters of this phase. The PAS evaluation revealed no penetration and aspiration in 26 of the cases (81.3%), while 1 had penetration and five had aspiration.
The patients with repaired EA-TEF may reveal deglutitive and respiratory symptoms in follow-up, necessitating certain investigations. The deglutition is functionally evaluated with VFS. While the disorders of oral and pharyngeal phases are less frequent and prominent, the esophageal phase reveals disorders with higher incidence and severity.
进行一项回顾性研究，以通过电视荧光吞咽造影（VFS）评估接受食管闭锁（EA）和/或气管食管瘘（TEF）手术的儿童的吞咽功能障碍。
对接受EA-TEF修复术的患者进行了畸形类型、手术方式、术后并发症、吞咽和呼吸症状以及胃食管反流病（GERD）方面的评估。在评估吞咽功能时记录吞咽困难评分、VFS在口腔、咽部和食管阶段的表现以及渗透-误吸量表（PAS）评分。
该研究纳入了32例患者，中位年龄为48个月（2-120个月），男女比例为14:18。大多数病例为C型大体畸形（n=26，81.3%），其他为A型（n=3）、D型（n=2）和E型（n=1）。合并畸形的发生率为71.8%。患者接受了一期（n=26，81.3%）或延期（n=6，18.7%）吻合术。术后并发症包括吻合口狭窄（n=12）、漏（n=2）和复发性瘘（n=2），分别通过扩张、保守治疗和瘘修补进行处理。病史记录中有复发性肺炎（n=13）、饮水时咳嗽（n=10）和食物嵌塞（n=7）。GERD的治疗包括药物治疗（n=11）和手术治疗（n=7）。吞咽困难评分中位数为3.5（最小值：0-最大值：27）。大多数病例（n=29，90.6%）的VFS口腔阶段正常。只有3例有轻度或中度损害，无重度损害。23例（71.8%）的咽部阶段无损害，仅3例在喉上抬和气道关闭参数方面观察到重度损害。与吞咽的前两个阶段相反，只有2例（6.3%）的食管阶段正常。在其他30例有损害的病例中，只有2例为轻度，其余为中度至重度问题。食管反流、动力和残留物是该阶段受损最严重的参数。PAS评估显示，26例（81.3%）无渗透和误吸，1例有渗透，5例有误吸。
接受EA-TEF修复术的患者在随访中可能出现吞咽和呼吸症状，需要进行某些检查。通过VFS对吞咽功能进行评估。虽然口腔和咽部阶段的障碍较少见且不突出，但食管阶段的障碍发生率更高且更严重。
