LaSalle A J, Andrassy R J, Ver Steeg K, Ratner I
J Thorac Cardiovasc Surg. 1979 Oct;78(4):583-8.
Congenital tracheoesophageal fistula (TEF) without esophageal atresia, commonly referred to as H-type fistula, comprises only 4.2% of all TEF's. Four infants with this entity were surgically treated at Santa Rosa Children's Hospital during the period of 1974 to 1977, and their diagnosis, surgical management, and hospital course are described in detail. H-type TEF is characterized by a clinical triad consisting of paroxysms of coughing precipitated by feeding, gaseous distention of the gastrointestinal tract, and pneumonitis. Demonstration of H-type TEF can be difficult and may be accomplished only by repeated examinations. The esophagogram using cinefluoroscopy and image intensification is the primary diagnostic technique utilized. If this is nondiagnostic, then tracheobronchoscopy should be performed in conjunction with ancillary techniques which improve endoscopic yield. Surgical correction can be accomplished through a cervical approach in 80% of cases. Preoperatival treatment of H-type TEF is dependent upon a high index of suspicion, an aggressive diagnostic approach, and prompt surgical correction. Our series of patients demonstrates that early diagnosis is feasible.
先天性食管气管瘘（TEF）而无食管闭锁，通常称为H型瘘，仅占所有TEF的4.2%。1974年至1977年期间，圣罗莎儿童医院对4例患有该病症的婴儿进行了手术治疗，并详细描述了他们的诊断、手术处理及住院过程。H型TEF的特征是由喂食引发的阵发性咳嗽、胃肠道气体扩张及肺炎构成的临床三联征。H型TEF的诊断可能困难，可能仅通过反复检查才能完成。使用电影荧光透视和影像增强的食管造影是主要的诊断技术。如果此项检查无法确诊，则应结合提高内镜检查阳性率的辅助技术进行气管支气管镜检查。80%的病例可通过颈部入路完成手术矫正。H型TEF的术前治疗取决于高度的怀疑指数、积极的诊断方法及迅速的手术矫正。我们的系列患者表明早期诊断是可行的。
