Tröbs R B, Finke W, Bahr M, Roll C, Nissen M, Vahdad M R, Cernaianu G
Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, D-44627, Herne, Widumer Str. 8, Germany.
Department of Anesthesiology and Surgical Intensive Care, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, D-44627, Herne, Widumer Str. 8, Germany.
Int J Pediatr Otorhinolaryngol. 2017 Mar;94:104-111. doi: 10.1016/j.ijporl.2017.01.022. Epub 2017 Jan 21.
We compared the postnatal course, morbidity and early results after repair for cases of isolated or "pure" TEF with those for cases of esophageal atresia (EA) with distal tracheoesophageal fistula (TEF).
Twenty-four consecutive infants were divided into two groups: isolated TEF [TEF group] (n = 5) and EA with distal TEF [EA group] (n = 19).
A high rate of prematurity (29%) and major cardiac and other surgically-relevant malformations (0.8 vs. 0.7 per infant) was found in both groups. The median age at surgery was 8 days for the TEF group vs. 1 day for the EA group (p < 0.01). Most infants of both cohorts had stable acid-base and respiratory parameters at admission. Generally, tracheoscopy provided valuable information regarding the position of the TEF. Surgery for isolated TEF was performed via right cervicotomy in 4 cases and via thoracotomy in one. Postoperative thoracostomy tubes were inserted in 3 cases and one emergency gastrostomy was created for acute gastric overextension (exclusively in patients with EA). The duration of postoperative mechanical ventilation (49 vs. 113 h, p = 0.045) and the median length of stay in the pediatric surgery unit (10 vs. 20.5 days, p = 0.003) were shorter for the isolated TEF group. Four EA patients experienced severe events. Total mortality was 8% (0 out of 5 with TEF vs. 2 out of 19 with EA).
Developmental delay and a high rate of morbidity were found in both groups. More complex surgery increased perioperative morbidity in cases of EA. With early recognition of isolated TEF, a less complicated course can be expected in comparison with esophageal atresia.
我们比较了单纯性或“纯”食管气管瘘（TEF）病例与伴有远端气管食管瘘（TEF）的食管闭锁（EA）病例的产后病程、发病率及修复术后的早期结果。
连续24例婴儿被分为两组：单纯性TEF[TEF组](n = 5)和伴有远端TEF的EA[EA组](n = 19)。
两组均发现早产率较高（29%）以及严重心脏和其他与手术相关的畸形（每名婴儿分别为0.8例和0.7例）。TEF组手术时的中位年龄为8天，而EA组为1天（p < 0.01）。两个队列中的大多数婴儿入院时酸碱和呼吸参数稳定。一般来说，气管镜检查为TEF的位置提供了有价值的信息。4例单纯性TEF手术通过右颈部切开术进行，1例通过开胸手术进行。3例术后插入胸腔闭式引流管，1例因急性胃扩张行急诊胃造瘘术（仅用于EA患者）。单纯性TEF组术后机械通气时间（49 vs. 113小时，p = 0.045）和小儿外科病房的中位住院时间（10 vs. 20.5天，p = 0.003）较短。4例EA患者发生严重事件。总死亡率为8%（TEF组5例中0例，EA组19例中2例）。
两组均发现发育迟缓且发病率较高。EA病例中更复杂的手术增加了围手术期发病率。与食管闭锁相比，早期识别单纯性TEF可预期病程较不复杂。
