Thakkar Hemanshoo, Upadhyaya Manasvi, Yardley Iain E
Evelina Children's Hospital, Guy's & St. Thomas's NHS Foundation Trust, London, UK.
Evelina Children's Hospital, Guy's & St. Thomas's NHS Foundation Trust, London, UK.
J Pediatr Surg. 2018 Feb;53(2):227-229. doi: 10.1016/j.jpedsurg.2017.11.003. Epub 2017 Nov 11.
Oesophagealatresia/tracheo-oesophageal fistula (OA-TOF) is associated with tracheomalacia (TM). In our institution it is routine for OA-TOF patients to undergo dynamic flexible bronchoscopy (DFB) assessing both the site of the fistula and the presence or absence of TM. We aimed to determine the value of this investigation as a screening tool to predict subsequent symptomatic tracheomalacia in these patients.
All patients with OA-TOF who underwent DFB at the time of initial repair between June 2014 and November 2016 were included prospectively. The findings at DFB were recorded. Patients were grouped according to the presence or absence of TM and followed to determine which of them developed symptomatic airway problems. The sensitivity and specificity of TM at initial bronchoscopy as a screening tool for subsequent symptomatic TM were calculated. The study was given ethical approval by our institution.
Twenty-three patients were included in the study. Median follow-up was for 7 (1-27) months. Fifteen (65%) were found to have TM at their first DFB; 13 (57%) subsequently developed airway symptoms, and of these 11 had TM at initial DFB. One patient with severe TM (>90% tracheal collapse) at initial DFB was completely asymptomatic following OA-TOF repair. The sensitivity was 85%, and specificity was 60%. The positive and negative predictive values were 73% and 75%, respectively.
DFB is a useful tool in many aspects of the management of OA/TOF. However, it is not a good screening tool to predict symptomatic tracheomalacia with moderate sensitivity and a low specificity.
Level IIb, Retrospective cohort study.
食管闭锁/气管食管瘘（OA - TOF）与气管软化（TM）相关。在我们机构，OA - TOF患者常规接受动态柔性支气管镜检查（DFB），以评估瘘管部位以及是否存在TM。我们旨在确定这项检查作为预测这些患者后续症状性气管软化的筛查工具的价值。
前瞻性纳入2014年6月至2016年11月期间在初次修复时接受DFB的所有OA - TOF患者。记录DFB的检查结果。根据是否存在TM对患者进行分组，并进行随访以确定哪些患者出现了症状性气道问题。计算初次支气管镜检查时TM作为后续症状性TM筛查工具的敏感性和特异性。本研究获得了我们机构的伦理批准。
23例患者纳入研究。中位随访时间为7（1 - 27）个月。15例（65%）在首次DFB时被发现有TM；13例（57%）随后出现气道症状，其中11例在初次DFB时有TM。1例在初次DFB时患有严重TM（气管塌陷>90%）的患者在OA - TOF修复后完全无症状。敏感性为85%，特异性为60%。阳性预测值和阴性预测值分别为73%和75%。
DFB在OA/TOF管理的许多方面是一种有用的工具。然而，它不是一个预测症状性气管软化的良好筛查工具，其敏感性中等且特异性较低。
IIb级，回顾性队列研究。
