Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan.
J Laparoendosc Adv Surg Tech A. 2023 Mar;33(3):291-295. doi: 10.1089/lap.2022.0141. Epub 2023 Feb 3.
The value of intraoperative bronchoscopic inspection (IBI) for accurate confirmation of the location and distance between the distal tracheoesophageal fistula (TEF) and the proximal blind end of the esophagus (GAP) was evaluated in Type C esophageal atresia (EA)+TEF. IBI involved inserting the tip of a bronchoscope into the TEF and a nasogastric tube into the blind end of the EA and measuring GAP with fluoroscopy. EA+TEF patients ( = 23) treated thoracoscopically between 2007 and 2020 were classified according to IBI as IBI+ ( = 16) and IBI- ( = 7) to compare demographics, operative time, and time taken for TEF division. Demographics were similar. Mean time for TEF division (15.4 ± 4.6 minutes for IBI+ versus 38.6 ± 20.9 minutes for IBI-; < .05) and mean operative time (215.3 ± 48.9 minutes for IBI+ versus 286.4 ± 51.7 minutes for IBI+; < .05) were significantly shorter. Mean GAP measured radiographically was 0.5 cm (range: 0-1.2 cm); mean GAP measured with IBI was 0.9 cm (range: 0-2.2 cm). Postoperative complications were 3 anastomotic leakages (1/16 in IBI+ and 2/7 in IBI-) that resolved without surgery and 8 strictures (3/16 in IBI+ and 5/7 in IBI-) treated by dilatation. IBI was effective for measuring GAP and is recommended for improving the efficiency of thoracoscopic repair.
在 C 型食管闭锁（EA）+气管食管瘘（TEF）中，评估了术中支气管镜检查（IBI）对准确确认远端 TEF 与食管近端盲端（GAP）之间的位置和距离的价值。IBI 涉及将支气管镜尖端插入 TEF，将鼻胃管插入 EA 的盲端，并通过透视测量 GAP。2007 年至 2020 年间接受胸腔镜治疗的 EA+TEF 患者（ = 23）根据 IBI 分为 IBI+（ = 16）和 IBI-（ = 7），以比较人口统计学、手术时间和 TEF 切开时间。 人口统计学特征相似。TEF 切开时间（IBI+为 15.4 ± 4.6 分钟，IBI-为 38.6 ± 20.9 分钟； < .05）和手术总时间（IBI+为 215.3 ± 48.9 分钟，IBI-为 286.4 ± 51.7 分钟； < .05）明显缩短。影像学测量的平均 GAP 为 0.5 cm（范围：0-1.2 cm）；IBI 测量的平均 GAP 为 0.9 cm（范围：0-2.2 cm）。术后并发症有 3 例吻合口漏（IBI+中为 1/16，IBI-中为 2/7），无需手术即可解决，8 例狭窄（IBI+中为 3/16，IBI-中为 5/7）通过扩张治疗。IBI 可有效测量 GAP，推荐用于提高胸腔镜修复的效率。
