儿童食管异物致气管食管瘘的临床特点及诊治经验  

Clinical characteristics and treatments of tracheoesophageal fistula due to esophageal foreign body in children

作　　者：赵勇 黄金狮 华凯云 谷一超 李爽爽 廖俊敏 张雅楠[1] 杨深 王沛则 陈永卫[1] Zhao Yong;Huang Jinshi;Hua Kaiyun;Gu Yichao;Li Shuangshuang;Liao Junmin;Zhang Yanan;Yang Shen;Wang Peize;Chen Yongwei(Department of Neonatal Surgery,Beijing Children's Hospital,Capital Medical University,National Center of Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院新生儿外科,100045

出　　处：《中华小儿外科杂志》2021年第11期971-976,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的总结儿童食管异物致气管食管瘘的临床特点及诊治经验。方法回顾性分析首都医科大学附属北京儿童医院2014年1月至2019年12月收治的15例食管异物致气管食管瘘患儿的临床资料。其中,男9例,女6例;发病年龄13~100个月,中位年龄21个月。记录患儿异物类型、异物存留时间、诊断方法、瘘口位置、主要早期症状、近远期并发症、外科干预策略及预后情况。结果本研究纳入15例患儿的异物类型包括纽扣电池13例,圆形塑料片1例,塑料带齿玩具1例;异物存留时间为6 h至6个月;瘘口位置位于食管上段12例,食管中段3例;主要早期症状为发热13例,呛咳15例,咳嗽咳痰13例,呼吸困难3例;其他近远期并发症包括肺炎15例,颈部软组织感染2例,声带麻痹2例,食管狭窄2例。15例患儿中,9例经抗感染、抑酸、雾化、保留胃管或空肠喂养管、胃造瘘营养支持后治愈,3例行手术治疗治愈,1例放置食管覆膜支架后死亡,2例留置空肠喂养管保守治疗后治愈。14例患儿获得随访,2例留置空肠喂养管随访中,余12例无其他并发症。结论纽扣电池是致气管食管瘘最常见的异物,发热、呛咳、咳嗽咳痰等呼吸道症状是气管食管瘘的早期预警症状,多数气管食管瘘可不经手术修补而自行愈合。经综合治疗,大多数食管异物导致的气管食管瘘预后良好。Objective To summarize the clinical characteristics and treatments of tracheoesophageal fistula(TEF)due to esophageal foreign body(FB)in children.Methods From January 2014 to December 2019,clinical data were retrospectively reviewed for 15 hospitalized children with TEF due to esophageal FB.There were 9 boys and 6 girls with a median onset age of 21(13-100)months.Type of FB,duration of FB retention,location of fistula,major early symptoms,short/long-term complications,surgical interventions and outcomes were recorded.Results The specific types of FB were button battery(n=13),round plastic sheet(n=1),plastic toothed toys(n=1);FB retention time was 6 hours to 6 months;fistula position:upper esophagus(n=12),middle esophagus(n=3);major early symptoms:fever(n=13),choking(n=15),cough&sputum(n=13)and dyspnea(n=3);short/long-term complications:pneumonia(n=15),neck soft tissue infection(n=2),vocal cord paralysis(n=2)and esophageal stenosis(n=2).Among them,9 cases were cured after anti-infection,acid suppression,nebulization,gastric or jejunal tube feeding and gastrostomic nutrition support.There were curing after repairing cervical TEF(n=2),thoracoscopic repairing(n=1),death after esophageal stenting(n=1)and subsequent jejunal tube feeding(n=2).All fourteen survived children were followed up for 4 months to 6 years,two children were still treated conservatively,twelve children were no other complication occurred.Conclusions Button battery is the most common FB causing TEF.Respiratory symptoms of fever,choking,cough and sputum are early warning symptoms of TEF.After comprehensive treatments,TEF due to esophageal FB has an excellent prognosis.

关 键 词：气管食管瘘 食管异物 治疗结果 

分 类 号：R768.32[医药卫生—耳鼻咽喉科]