Fallon Sara C, Langer Jacob C, St Peter Shawn D, Tsao KuoJen, Kellagher Caroline M, Lal Dave R, Whitehouse Jill S, Diesen Diana L, Rollins Michael D, Pontarelli Elizabeth, Malek Marcus M, Iqbal Corey W, Upperman Jeffrey S, Leys Charles M, Wulkan Mark L, Hill Sarah J, Blakely Martin L, Kane Timothy D, Wesson David E
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St. Suite 1210, Houston, TX 77030, USA.
Hospital for Sick Children, Dept of Ped Surg, 555 University Ave, Rm 1526, Toronto, ON M5G 1X8, Canada.
J Pediatr Surg. 2017 Nov;52(11):1711-1714. doi: 10.1016/j.jpedsurg.2017.05.002. Epub 2017 May 11.
To perform a multicenter review of outcomes in patients with H-type tracheoesophageal fistula (TEF) in order to better understand the incidence and causes of post-operative complications.
H-type TEF without esophageal atresia (EA) is a rare anomaly with a fundamentally different management algorithm than the more common types of EA/TEF. Outcomes after surgical treatment of H-type TEF are largely unknown, but many authoritative textbooks describe a high incidence of respiratory complications.
A multicenter retrospective review of all H-type TEF patients treated at 14 tertiary children's hospital from 2002-2012 was performed. Data were systematically collected concerning associated anomalies, operative techniques, hospital course, and short and long-term outcomes. Descriptive analyses were performed.
We identified 102 patients (median 9.5 per center, range 1-16) with H-type TEF. The overall survival was 97%. Most patients were repaired via the cervical approach (96%). The in-hospital complication rate, excluding vocal cord issues, was 16%; this included an 8% post-operative leak rate. Twenty-two percent failed initial extubation after repair. A total of 22% of the entire group had vocal cord abnormalities (paralysis or paresis) on laryngoscopy that were likely because of recurrent laryngeal nerve injury. Nine percent required a tracheostomy. Only 3% had a recurrent fistula, all of which were treated with reoperation.
There is a high rate of recurrent laryngeal nerve injury after H-type TEF repair. This underscores the need for meticulous surgical technique at the initial repair and suggests that early vocal cord evaluation should be performed for any post-operative respiratory difficulty. Routine evaluation of vocal cord function after H-type TEF repair should be considered.
Level IV.
对H型气管食管瘘（TEF）患者的治疗结果进行多中心回顾，以更好地了解术后并发症的发生率及原因。
无食管闭锁（EA）的H型TEF是一种罕见的畸形，其处理原则与更常见的EA/TEF类型有根本不同。H型TEF手术治疗后的结果很大程度上未知，但许多权威教科书描述呼吸并发症发生率很高。
对2002年至2012年期间在14家三级儿童医院接受治疗的所有H型TEF患者进行多中心回顾性研究。系统收集有关相关畸形、手术技术、住院过程以及短期和长期结果的数据，并进行描述性分析。
我们确定了102例H型TEF患者（每个中心中位数为9.5例，范围为1至16例）。总体生存率为97%。大多数患者通过颈部入路进行修复（96%）。排除声带问题后的院内并发症发生率为16%；其中术后漏率为8%。修复后首次拔管失败率为22%。整个队列中有22%的患者在喉镜检查时出现声带异常（麻痹或轻瘫），这可能是由于喉返神经损伤所致。9%的患者需要气管切开术。只有3%的患者出现复发性瘘管，所有这些患者均接受了再次手术治疗。
H型TEF修复术后喉返神经损伤发生率很高。这突出了初次修复时需要精细的手术技术，并表明对于任何术后呼吸困难都应尽早进行声带评估。应考虑对H型TEF修复术后的声带功能进行常规评估。
四级。
