van Hal Anne-Fleur R L, Aanen Irene P, Wijnen René M H, Pullens Bas, Vlot John
Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
J Pediatr Surg. 2024 Nov;59(11):161620. doi: 10.1016/j.jpedsurg.2024.07.005. Epub 2024 Jul 14.
Oesophageal atresia (OA) is often accompanied by tracheomalacia (TM). The aim of this study was to evaluate its presence in OA patients during routine rigid tracheobronchoscopy (TBS) before primary correction and compare this to postoperative TBS and clinical signs of TM.
This retrospective cohort study included patients born with OA between June 2013 and December 2022 who had received a TBS before OA correction and had been followed for at least twelve months. Definite TM was postoperatively diagnosed through TBS, and probable TM was defined as having symptoms of TM.
We analysed data from 79 patients, of whom 87% with OA type C. Preoperatively, TM was observed in 33 patients (42% of all patients), seven of whom had severe TM. Definite TM was observed in 21 patients (27%), of whom 15 had severe TM. Forty-one patients (52% of all patients) had developed symptoms of TM within twelve months, including harsh barking cough (n = 15), stridor and/or wheezing (n = 20), recurrent respiratory insufficiency (n = 11), or needing airway surgery (n = 7). The sensitivity of preoperative TBS for the presence of postoperative (definite and probable combined) TM is 50.0%, 95% CI [35.2-64.8], and the specificity 67.6%, 95% CI [51.7-81.1]. Clinical characteristics did not differ between the patients with or without postoperative TM.
More than half of the studied patients with OA experienced symptoms of TM. While preoperative TBS is routinely performed prior to surgical OA correction, its predictive value for the presence of postoperative TM remains limited.
Level II.
Study of Diagnostics Test.
食管闭锁（OA）常伴有气管软化（TM）。本研究的目的是评估在初次矫正前的常规硬质气管支气管镜检查（TBS）期间OA患者中TM的存在情况，并将其与术后TBS及TM的临床体征进行比较。
这项回顾性队列研究纳入了2013年6月至2022年12月期间出生的患有OA且在OA矫正前接受过TBS并随访至少12个月的患者。术后通过TBS诊断明确的TM，可能的TM定义为有TM症状。
我们分析了79例患者的数据，其中87%为C型OA。术前，33例患者（占所有患者的42%）观察到TM，其中7例有严重TM。21例患者（27%）观察到明确的TM，其中15例有严重TM。41例患者（占所有患者的52%）在12个月内出现了TM症状，包括犬吠样咳嗽（n = 15）、喘鸣和/或喘息（n = 20）、反复呼吸功能不全（n = 11）或需要气道手术（n = 7）。术前TBS对术后（明确和可能的合并）TM存在的敏感性为50.0%，95%CI[35.2 - 64.8]，特异性为67.6%，95%CI[51.7 - 81.1]。有或无术后TM的患者临床特征无差异。
超过一半的研究OA患者出现了TM症状。虽然术前TBS在OA手术矫正前常规进行，但其对术后TM存在的预测价值仍然有限。
二级。
诊断试验研究。
