Kemmotsu H, Joe K, Nakamura H, Yamashita M
Department of Pediatric Surgery, Ibaraki Children's Hospital, Mito, Japan.
J Pediatr Surg. 1995 Apr;30(4):549-52. doi: 10.1016/0022-3468(95)90128-0.
Repair of esophageal atresia is usually performed by a thoracic approach. In cases associated with a tracheoesophageal fistula (TEF) located in a high position, however, the cervical approach is a reasonable alternative. In the literature, the authors found only three patients repaired by this approach. This report describes three additional cases of esophageal atresia successfully repaired by the cervical approach. Three neonates with esophageal atresia and TEF were confirmed as having an unusually high position of the distal TEF by the preoperative bronchoscopy and contrast study. The transcervical approach for repair was chosen. The skin was incised transversely at the right supraclavicular region, and the sternocleidomastoid muscle and the carotid sheath were retracted posterolaterally. After the division of the TEF, the suture site of the tracheal fistula was covered by a flap of the sternothyroid muscle that was inserted between the trachea and the esophagus, thus avoiding opposing suture lines. These cases emphasize that pediatric surgeons should be aware of the presence of cervical esophageal atresia in which distal TEF is located above the clavicle, and suggest that cervical repair is feasible for the patient whose distal TEF moves up above the first rib on inspiration. The most reliable methods for detecting the location of the distal TEF are telescopic bronchoscopy and contrast study.
食管闭锁修复术通常采用开胸手术。然而，对于伴有高位气管食管瘘（TEF）的病例，颈部手术是一种合理的替代方法。在文献中，作者仅发现3例采用该方法修复的患者。本报告描述了另外3例通过颈部手术成功修复食管闭锁的病例。3例患有食管闭锁和TEF的新生儿通过术前支气管镜检查和造影研究被证实远端TEF位置异常高。选择经颈部手术进行修复。在右锁骨上区域横向切开皮肤，将胸锁乳突肌和颈动脉鞘向外侧后方牵开。切断TEF后，气管瘘的缝合部位用插入气管和食管之间的胸骨甲状肌瓣覆盖，从而避免缝合线相对。这些病例强调小儿外科医生应意识到存在远端TEF位于锁骨上方的颈部食管闭锁情况，并表明对于吸气时远端TEF上移至第一肋骨上方的患者，颈部修复是可行的。检测远端TEF位置最可靠的方法是可伸缩支气管镜检查和造影研究。
