Hacettepe University, Ihsan Dogramacı Children's Hospital, Pediatric Pulmonology, Ankara, Turkey.
Hacettepe University, Ihsan Dogramacı Children's Hospital, Pediatric Surgery, Turkey.
Respir Med. 2021 May;181:106376. doi: 10.1016/j.rmed.2021.106376. Epub 2021 Mar 28.
Recurrent pulmonary infections, wheezing and stridor due to swallowing dysfunction, esophageal dysmotility, gastroesophageal reflux, tracheomalacia and bronchomalacia are frequently seen complications after esophageal atresia and tracheo-esophageal fistula (EA-TEF) surgeries. This study aimed to investigate the frequency and causes of respiratory problems and to evaluate the factors that affect respiratory morbidity in patients who had undergone EA-TEF repair in a tertiary referral center.
Preoperative and postoperative records of patients with EA, TEF + EA and isolated EA were examined retrospectively. Accompanied diseases and swallowing dysfunction symptoms were questioned. Bronchoalveolar lavage results were investigated if the patient had flexible bronchoscopy.
A total of 71 children with EA were included in the study, and seven patients who did not have follow-up after surgery were excluded. 46 of the 64 patients continue regular follow-up visits in our department. Male sex, primary EA repair in another center, EA type C, accompanying genetic anomalies, severe tracheomalacia, late per oral feeding (1 year after surgery), and severe GER were found to cause significantly higher incidence of coughing, recurrent wheezing, recurrent pneumonia, and bronchiectasis despite surgical and medical treatments (p = 0.048, p = 0.045, p = 0.009, p = 0.029, p = 0.025). CONCLUSİON: Even if anatomical anomalies are corrected by surgery in patients who underwent EA repair, precautions can be taken for GERD, laryngotracheomalacia, and swallowing dysfunction, and effective pulmonary rehabilitation can be initiated with early multidisciplinary approach before the development of respiratory tract symptoms.
食管闭锁和食管气管瘘（EA-TEF）手术后常出现吞咽功能障碍、食管动力障碍、胃食管反流、气管软化和支气管软化引起的复发性肺部感染、喘息和喘鸣。本研究旨在探讨呼吸问题的频率和原因，并评估在三级转诊中心接受 EA-TEF 修复的患者中影响呼吸发病率的因素。
回顾性检查 EA、TEF+EA 和单纯 EA 患者的术前和术后记录。询问伴随疾病和吞咽功能障碍症状。如果患者进行了软性支气管镜检查，则调查支气管肺泡灌洗结果。
共有 71 例 EA 患儿纳入本研究，7 例术后无随访患儿被排除。64 例患者中有 46 例继续在我科定期随访。男性、在其他中心初次 EA 修复、EA 型 C、伴发遗传异常、严重气管软化、经口喂养延迟（术后 1 年）和严重 GER 导致咳嗽、复发性喘息、复发性肺炎和支气管扩张的发生率显著更高，尽管进行了手术和药物治疗（p=0.048、p=0.045、p=0.009、p=0.029、p=0.025）。结论：即使在接受 EA 修复的患者中通过手术纠正了解剖异常，也可以针对 GERD、喉气管软化和吞咽功能障碍采取预防措施，并在呼吸道症状出现之前，通过早期多学科方法开始有效的肺部康复。
