Diagnose and treatment for Type D congenital esophageal atresia with tracheoesophageal fistula  

作　　者：Dingding Wang Yong Zhao Yanan Zhang Kaiyun Hua Yichao Gu Shuangshuang Li Junmin Liao Shen Yang Ting Yang Jiawei Zhao Jinshi Huang 

机构地区：[1]Department of Neonatal Surgery,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing,China

出　　处：《Pediatric Investigation》2024年第1期37-43,共7页儿科学研究（英文）

基　　金：Natural Science Foundation of Jiangxi,China:Grant/Award Number:81660092;Beijing Municipal Science&Technology Commission:Grant/Award Number:Z2102921062。

摘　　要：Importance:Type D esophageal atresia(EA)with tracheoesophageal fistula(TEF)is characterized by EA with both proximal and distal TEFs.It is a rare congenital anomaly with a very low incidence.Objective:To investigate diagnostic and treatment strategies for this rare condition.Methods:We retrospectively reviewed the clinicopathological features of patients with EA/TEF treated at our institution between January 2007 and September 2021.Results:Among 386 patients with EA/TEF,14(3.6%)had type D EA/TEF.Only two patients were diagnosed with proximal TEF preoperatively.Seven patients were diagnosed intraoperatively.Five patients were missed for diagnosis during the initial surgery but was later confirmed by bronchoscopy.During the neonatal period,seven patients underwent a one-stage repair of proximal and distal TEF via thoracoscopy or thoracotomy.Due to missed diagnosis and other reasons,the other 7 patients underwent two-stage surgery for repair of the proximal TEF,including cervical incision and thoracoscopy.Ten of the 14 patients experienced postoperative complications including anastomotic leakage,pneumothorax,esophageal stricture,and recurrence.Patients who underwent one-stage repair of distal and proximal TEF during the neonatal period showed a higher incidence of anastomotic leak(4/7).In contrast,only one of seven patients with two-stage repair of the proximal TEF developed an anastomotic leak.Interpretation:Type D EA/TEF is a rare condition,and proximal TEFs are easily missed.Bronchoscopy may aim to diagnose and determine the correct surgical approach.A cervical approach may be more suitable for repairing the proximal TEF.

关 键 词：DIAGNOSIS THERAPY Tracheoesophageal fistula Type D congenital esophageal atresia 

分 类 号：R726.5[医药卫生—儿科]