Cincinnati Children's Hospital Medical Center, Department of Otolaryngology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Otolaryngology, Cincinnati, OH, USA.
Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Pediatrics, Cincinnati, OH, USA.
J Pediatr Surg. 2024 Nov;59(11):161880. doi: 10.1016/j.jpedsurg.2024.161880. Epub 2024 Aug 28.
Tracheomalacia severity is difficult to quantify, however, ultrashort echo-time MRI objectively quantifies tracheomalacia in infants without sedation, radiation, or intubation. Patients with tracheoesophageal fistula and esophageal atresia (TEF/EA) commonly have tracheomalacia, however, the relationship between tracheomalacia severity and esophageal atresia has not been well defined. The primary objective of this study was to establish the relationship between EA and tracheomalacia severity and identify possible predictors of tracheomalacia severity.
A retrospective review of neonates with TEF/EA who had previously undergone UTE MRI was performed. The trachea was divided into thirds. Maximal eccentricity in each third was calculated by measuring the anterior posterior dimension (MinD) and dividing it by the maximum width of the trachea (MaxD). Frequency of respiratory related admissions, number of upper respiratory infections, and number of steroids courses were quantified in addition to eccentricity in short and long gap esophageal atresia patients.
A total of 16 TEF/EA patients were included. Patients with long gap esophageal atresia had more severe tracheomalacia than short gap as measured by eccentricity in the upper (0.60 vs 0.72, p = 0.03), middle (0.48 vs 0.61, p = 0.02), and lower (0.5 vs 0.65, p = 0.01) trachea. Long gap esophageal atresia patients had more frequent respiratory readmissions (1.87 admissions/year vs 0.54 admissions/year) (p = 0.03). Following TEF/EA repair the trachea was less eccentric in the upper third (0.64 pre, 0.79 post, p < 0.01) and more eccentric in the lower third (0.69 pre, 0.56 post, p < 0.01).
Differences in esophageal gap and repair status correlate with airway eccentricity and tracheomalacia symptoms.
气管软化的严重程度难以量化，但超短回波时间 MRI 可在无需镇静、辐射或插管的情况下客观地量化婴儿的气管软化。气管食管瘘和食管闭锁（TEF/EA）患者通常存在气管软化，但气管软化的严重程度与食管闭锁之间的关系尚未得到很好的定义。本研究的主要目的是确定 EA 与气管软化严重程度的关系，并确定气管软化严重程度的可能预测因素。
对先前接受过 UTE MRI 的 TEF/EA 新生儿进行回顾性研究。将气管分为三部分。在每部分中，通过测量前后径（MinD）并将其除以气管的最大宽度（MaxD）来计算最大偏心度。除了短间隙和长间隙食管闭锁患者的偏心度外，还量化了与呼吸相关的入院频率、上呼吸道感染次数和类固醇疗程数。
共纳入 16 例 TEF/EA 患者。长间隙食管闭锁患者的气管软化比短间隙食管闭锁患者更严重，上、中、下气管的偏心度分别为 0.60 vs 0.72（p=0.03）、0.48 vs 0.61（p=0.02）和 0.5 vs 0.65（p=0.01）。长间隙食管闭锁患者的呼吸再入院频率更高（1.87 次/年 vs 0.54 次/年）（p=0.03）。TEF/EA 修复后，上三分之一气管的偏心度降低（0.64 术前，0.79 术后，p<0.01），下三分之一气管的偏心度增加（0.69 术前，0.56 术后，p<0.01）。
食管间隙和修复状态的差异与气道偏心度和气管软化症状相关。
