小儿气管食管瘘的围术期管理  

Perioperative care of tracheoesophageal fistula in children

作　　者：桂交交 郑华[1] GUI Jiaojiao;ZHENG Hua(Department of Anesthesiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,老年麻醉与围术期脑健康湖北省重点实验室,武汉市老年麻醉临床医学研究中心,430030

出　　处：《临床外科杂志》2023年第5期495-497,共3页Journal of Clinical Surgery

基　　金：湖北省卫生健康委员会资助项目(No.WJ2015MB059)。

摘　　要：气管食管瘘是一种由于先天或后天因素所致气管与食管之间形成异常通道的罕见疾病,其临床症状缺乏特异性,常被误诊为呼吸道或消化道疾病而延误治疗。手术治疗是该疾病目前有效的根治手段。气管食管瘘患儿常因反复误吸出现肺炎,导致肺顺应性下降、气管软化、支气管软化等并发症,严重影响患儿的生存质量和预后。术中受手术挤压,术侧通气受限;机械通气时瘘口通气,使膈肌抬高,进一步限制呼吸,增加术中低氧血症的发生率和胃破裂风险,使围术期管理成为一种挑战。本综述将总结该疾病的围术期管理方案和进展,为临床治疗提供参考。Tracheoesophageal fistula(TEF)is a rare disease caused by the formation of abnormal channels between the trachea and the esophagus due to the congenital or acquired factors.It is often misdiagnosed as a respiratory or gastrointestinal disease because of the lack of specific clinical symptoms,resulting in delayed treatment.Surgical treatment is an effective radical cure for this disease.TEF often develop pneumonia due to the repeated aspiration,leading to the decline of lung compliance,tracheomalacia,bronchomalacia and other complications,which affects the quality of life and the prognosis of children.During the operation,the ventilation of the operative side is limited due to the surgical compression.Fistula ventilation during mechanical ventilation can elevate the diaphragm.Moreover,it restricts breathing and increases the incidence of intraoperative hypoxemia and the risk of gastric rupture during the operation.Therefore,Perioperative care of TEF is a challenging.This review will summarize the strategies and progress of Perioperative care of TEF,and provide reference for clinical treatment.

关 键 词：小儿 气管食管瘘 围术期管理 

分 类 号：R726.5[医药卫生—儿科]