Demir Numan, Arslan Selen Serel, Yalcin Sule, Karaduman Ayşe, Tanyel Feridun Cahit, Soyer Tutku
Hacettepe University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ankara, Turkey.
Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
J Pediatr Surg. 2017 Oct;52(10):1580-1582. doi: 10.1016/j.jpedsurg.2017.04.001. Epub 2017 Apr 5.
A prospective study was performed to evaluate anatomical alterations and hyolaryngeal elevation (HE) by videofluoroscopic swallowing study (VFSS) in patients with esophageal atresia-tracheoesophageal fistula (EA-TEF).
Patients operated for EA-TEF were evaluated for age, sex, type of atresia and time to esophageal anastomosis. All patients were evaluated by videofluoroscopic swallowing study (VFSS). Penetration-Aspiration scale (PAS≥7 is considered as aspiration), distance between upper esophageal sphincter and 2nd cervical vertebrae (UES-C2) and hyolaryngeal elevation (HE) were evaluated by the same deglutitionist who was blind to the study. The results of EA-TEF patients were compared with healthy children.
Eighteen patients with EA-TEF and 10 healthy controls were included. The median age was 16months (12-36m) in EA-TEF and 18months (13-51m) in controls. Male-to-female ratio was 5:4 and 4:1 respectively. 12 of cases were isolated-EA, 1 of them was EA-proximal TEF and 5 of the cases were EA-distal TEF. Half of the cases had primary EAN and others underwent delayed esophageal repair. Early oral feeding was also started in 9 patients (50%) whereas others had delayed oral feeding. VFSS showed aspiration in 27.7 (n=5) of cases (PAS≥7) in EA group. The median distance between UES-C2 was 3.04cm (min: 2.17-max: 3.94) in EA and 4.17cm (min: 3.45-max: 6.24cm) in controls. Median distance for HE was 0.37cm (min: 0.18-max: 1.1cm) in EA and 1.15 (min: 0.61-max: 1.06cm) in controls. The distance between UES-C2 was significantly lower than controls (p<0.05) and HE was decreased in EA-TEF without any statistical significance.
Children with EA-TEF had shortened distance between airway and upper esophagus. HE may be inefficient to protect airway during deglutition. Anatomical alterations after EAN suggest that airway problems may be related with decreased HE in children with EATEF.
Level II (Development of diagnostic criteria in a consecutive series of patients and a universally applied "gold standard").
进行一项前瞻性研究，通过视频荧光吞咽造影检查（VFSS）评估食管闭锁-气管食管瘘（EA-TEF）患者的解剖结构改变和喉咽部抬高（HE）情况。
对接受EA-TEF手术的患者进行年龄、性别、闭锁类型及食管吻合时间的评估。所有患者均接受视频荧光吞咽造影检查（VFSS）。由对研究不知情的同一位吞咽专家评估渗透-误吸量表（PAS≥7被视为误吸）、食管上括约肌与第二颈椎之间的距离（UES-C2）以及喉咽部抬高（HE）。将EA-TEF患者的结果与健康儿童进行比较。
纳入18例EA-TEF患者和10例健康对照。EA-TEF组的中位年龄为16个月（12 - 36个月），对照组为18个月（13 - 51个月）。男女比例分别为5:4和4:1。12例为单纯食管闭锁，1例为食管闭锁-近端气管食管瘘，5例为食管闭锁-远端气管食管瘘。一半的病例进行了一期食管吻合术，其他病例接受了延迟食管修复。9例患者（50%）早期开始经口喂养，其他患者延迟经口喂养。VFSS显示EA组27.7%（n = 5）的病例存在误吸（PAS≥7）。EA组UES-C2的中位距离为3.04cm（最小值：2.17 - 最大值：3.94），对照组为4.17cm（最小值：3.45 - 最大值：6.24cm）。EA组HE的中位距离为0.37cm（最小值：0.18 - 最大值：1.1cm），对照组为1.15cm（最小值：0.61 - 最大值：1.06cm）。EA组UES-C2的距离显著低于对照组（p < 0.05），且EA-TEF组的HE降低，但无统计学意义。
EA-TEF患儿气道与食管上段之间的距离缩短。吞咽时HE可能无法有效保护气道。食管吻合术后的解剖结构改变表明，气道问题可能与EA-TEF患儿的HE降低有关。
二级（在一系列连续患者中制定诊断标准并采用普遍适用的“金标准”）。
