Department of Paediatric Surgery, Alder Hey Childrens' Hospital, Liverpool, UK.
Institute of Child Health, School of Health And Life Science, University of Liverpool, Liverpool, UK.
Pediatr Surg Int. 2021 May;37(5):539-547. doi: 10.1007/s00383-020-04853-3. Epub 2021 Jan 20.
H type tracheoesophageal fistula (H-TEF) is a rare congenital anomaly. Management may be complicated by late diagnosis and variation(s) in the therapeutic strategy. A systematic review of published studies explores the utility of diagnostic studies, operations and postoperative complications.
Medline and PubMed database(s) were searched for ALL studies reporting H-TEF during 1997-2020. Using PRISMA methodology, manuscripts were screened for eligibility and reporting.
Forty-seven eligible studies were analysed. Primary diagnosis varied widely with surgeons performing oesophagography and trachea-bronchoscopy. Preoperative localisation techniques included fluoroscopy, guidewire placement and catheterisation. A cervical approach (209 of 272 cases), as well as thoracotomy, thoracoscopy and endoscopic fistula ligation, were all described. Morbidity included fistula recurrence (1.7%), leak (2%), tracheomalacia (3.4%) and respiratory sequelae (1%). The major adverse complication in all studies was vocal cord palsy secondary to laryngeal nerve injury (18.5%) yet strikingly few centres routinely reported undertaking vocal cord screening pre or postoperatively.
This study shows that paediatric surgeons record low volume activity with H type tracheoesophageal fistula. Variation(s) in clinical practice are widely evident. Laryngeal nerve injury and its subsequent management warrant special consideration. Care pathways may offset attendant morbidity and define 'best practice.'
H 型气管食管瘘（H-TEF）是一种罕见的先天性异常。由于诊断较晚和治疗策略的变化，其管理可能较为复杂。对已发表的研究进行系统回顾，探讨了诊断研究、手术和术后并发症的应用价值。
检索了 Medline 和 PubMed 数据库中 1997 年至 2020 年期间所有关于 H-TEF 的研究。采用 PRISMA 方法，筛选文献的纳入标准和报告情况。
分析了 47 项符合条件的研究。主要诊断方法因外科医生而异，包括食管造影和气管支气管镜检查。术前定位技术包括透视、导丝放置和导管插入。描述了经颈入路（272 例中的 209 例）以及开胸术、胸腔镜和内镜瘘结扎术。发病率包括瘘复发（1.7%）、漏（2%）、气管软化（3.4%）和呼吸后遗症（1%）。所有研究中最主要的不良并发症是喉返神经损伤导致的声带麻痹（18.5%），但令人惊讶的是，很少有中心常规报告在术前或术后进行声带筛查。
本研究表明，小儿外科医生对 H 型气管食管瘘的手术量较低。临床实践中的差异广泛存在。喉返神经损伤及其后续管理值得特别关注。护理路径可能会降低相关发病率，并定义“最佳实践”。
