Poupore Nicolas S, Shih Michael C, Nguyen Shaun A, Brennan Emily A, Clemmens Clarice S, Pecha Phayvanh P, McDuffie Lucas A, Carroll William W
Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA.
Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
Int J Pediatr Otorhinolaryngol. 2022 Jun;157:111100. doi: 10.1016/j.ijporl.2022.111100. Epub 2022 May 3.
During the SARS-CoV-2 pandemic, the incidence of pediatric button battery (BB) ingestions has risen. Children have spent more time at home from school, while many parents try to balance working from home and childcare. Additionally, the amount of electronics powered by BB has increased. Tracheoesophageal fistula (TEF) secondary to a retained aerodigestive BB is a devastating development. Management is challenging, and the clinical timeline of watchful waiting versus surgical intervention for TEF is poorly defined in the literature.
In accordance with PRISMA guidelines, databases searched include PubMed, Scopus, and CINAHL from database date of inception through August 13, 2021. All study designs were included, and no language, publication date, or other restrictions were applied. Case series and reports of TEFs secondary to BBs were included. Clinical risk factors and outcomes were compared between the spontaneous closure and surgical repair groups.
A total of 79 studies with 105 total patients were included. Mortality was 11.4%. There were 23 (21.9%) TEFs that spontaneously closed and 71 (67.6%) that underwent surgical repair. Median time to spontaneous closure compared to surgical repair was significantly different (8.0 weeks [IQR 4.0-18.4] vs. 2.0 weeks [IQR 0.1-3.3], p<0.001). Smaller TEFs were more likely to spontaneously close versus being surgically repaired (9.3 mm ± 3.5 vs. 14.9 mm ± 8.3, p=0.022). Duration of symptoms before BB discovery, BB size, time between BB removal and TEF discovery, and location of the TEF were not statistically different between the spontaneous closure and surgical repair groups.
A TEF secondary to BB ingestion is a potentially deadly complication. Timing of reported TEF spontaneous closure varies significantly. While smaller TEFs may be amenable to healing without surgical repair, no other significant factors were identified that may be associated with spontaneous closure. If clinical status permits, these data suggest a period of observation of at least 8 weeks prior to surgical intervention may be practical for many BB-induced TEFs.
在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行期间，儿童吞食纽扣电池（BB）的发生率有所上升。儿童放学在家的时间增多，而许多家长试图平衡在家工作和照顾孩子。此外，由纽扣电池供电的电子产品数量增加。因呼吸道消化道纽扣电池残留继发的气管食管瘘（TEF）是一个灾难性的进展。管理具有挑战性，并且在文献中，对于TEF观察等待与手术干预的临床时间线定义不明确。
按照系统评价和荟萃分析优先报告项目（PRISMA）指南，检索的数据库包括从数据库建立之日起至2021年8月13日的PubMed、Scopus和护理学与健康领域数据库（CINAHL）。纳入所有研究设计，不设语言、出版日期或其他限制。纳入纽扣电池继发气管食管瘘的病例系列和报告。比较自发闭合组和手术修复组的临床危险因素和结局。
共纳入79项研究，总计105例患者。死亡率为11.4%。有23例（21.9%）气管食管瘘自发闭合，71例（67.6%）接受了手术修复。自发闭合与手术修复的中位时间有显著差异（8.0周[四分位间距4.0 - 18.4] vs. 2.0周[四分位间距0.1 - 3.3]，p<0.001）。较小的气管食管瘘比较大的气管食管瘘更有可能自发闭合而非接受手术修复（9.3毫米±3.5 vs. 14.9毫米±8.3，p = 0.022）。纽扣电池发现前的症状持续时间、纽扣电池大小、纽扣电池取出与气管食管瘘发现之间的时间以及气管食管瘘的位置，在自发闭合组和手术修复组之间无统计学差异。
纽扣电池吞食继发的气管食管瘘是一种潜在致命的并发症。报告的气管食管瘘自发闭合时间差异很大。虽然较小的气管食管瘘可能无需手术修复即可愈合，但未发现其他可能与自发闭合相关的显著因素。如果临床状况允许，这些数据表明对于许多纽扣电池所致的气管食管瘘，在手术干预前至少观察8周可能是可行的。
