Baxter Katherine J, Baxter Lauren M, Landry April M, Wulkan Mark L, Bhatia Amina M
Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States.
Department of Speech Pathology, Children's Healthcare of Atlanta, Atlanta, GA, United States.
J Pediatr Surg. 2018 Sep;53(9):1655-1659. doi: 10.1016/j.jpedsurg.2017.12.025. Epub 2018 Jan 31.
Long-term dysphagia occurs in up to 50% of repaired esophageal atresia and tracheoesophageal fistula (EA/TEF) patients. The underlying factors are unclear and may include stricture, esophageal dysmotility, or associated anomalies. Our purpose was to determine whether structural airway abnormalities (SAA) are associated with dysphagia in EA/TEF.
We conducted a retrospective chart review of children who underwent EA/TEF repair in our hospital system from 2007 to 2016. Children with identified SAA (oropharyngeal abnormalities, laryngeal clefts, laryngomalacia, vocal cord paralysis, and tracheomalacia) were compared to those without airway abnormalities. Dysphagia outcomes were determined by the need for tube feeding and the modified pediatric Functional Oral Intake Scale (FOIS) at 1 year.
SAA was diagnosed in 55/145 (37.9%) patients with EA/TEF. Oropharyngeal aspiration was more common in children with SAA (58.3% vs. 36.4%, p=0.028). Children with SAA were more likely to require tube feeding both at discharge (79.6% vs. 48.3%, p<0.001) and at 1 year (52.7% vs. 13.6%, p<0.001) and had lower mean FOIS (4.18 vs. 6.21, p<0.001). In the logistic regression model adjusting for gestational age, long gap EA, and esophageal stricture, the presence of SAA remained a significant risk factor for dysphagia (OR 4.17 (95% CI 1.58-11.03)).
SAA are common in children with EA/TEF and are associated with dysphagia, even after accounting for gestational age, esophageal gap and stricture. This study highlights the need for a multidisciplinary approach, including early laryngoscopy and bronchoscopy, in the evaluation of the EA/TEF child with dysphagia.
Level II retrospective prognostic study.
在接受食管闭锁及气管食管瘘（EA/TEF）修复术的患者中，高达50%会出现长期吞咽困难。其潜在因素尚不清楚，可能包括狭窄、食管动力障碍或相关畸形。我们的目的是确定结构性气道异常（SAA）是否与EA/TEF患者的吞咽困难有关。
我们对2007年至2016年在我院系统接受EA/TEF修复术的儿童进行了回顾性病历审查。将确诊为SAA（口咽异常、喉裂、喉软化、声带麻痹和气管软化）的儿童与无气道异常的儿童进行比较。吞咽困难结局通过1岁时是否需要管饲以及改良的儿科功能性口服摄入量量表（FOIS）来确定。
145例EA/TEF患者中有55例（37.9%）被诊断为SAA。SAA患儿口咽误吸更为常见（58.3%对36.4%，p = 0.028）。SAA患儿在出院时（79.6%对48.3%，p<0.001）和1岁时（52.7%对13.6%，p<0.001）更有可能需要管饲，且平均FOIS较低（4.18对6.21，p<0.001）。在调整了胎龄、长节段EA和食管狭窄的逻辑回归模型中，SAA的存在仍然是吞咽困难的一个重要危险因素（比值比4.17（95%可信区间1.58 - 11.03））。
SAA在EA/TEF患儿中很常见，并且与吞咽困难有关，即使在考虑了胎龄、食管长度和狭窄因素之后。本研究强调在评估有吞咽困难的EA/TEF患儿时需要采取多学科方法，包括早期喉镜检查和支气管镜检查。
二级回顾性预后研究。
