儿童单纯性气管食管瘘的临床诊治分析

发布时间：2018-03-26 03:45

本文选题：单纯性气管食管瘘　切入点：先天性/获得性气管食管瘘　出处：《重庆医科大学》2017年硕士论文

【摘要】：目的:总结儿童单纯性气管食管瘘的临床诊治经验,提高诊治水平。方法:回顾性分析我院1998年2月至2017年1月诊治的20例单纯性气管食管瘘患儿的临床病例资料,男11例,女9例;年龄范围5天~47月,6月9例,6月-12月5例,12月-36月4例,36月2例;先天性H型气管食管瘘14例,获得性气管食管瘘6例;通过食管造影确诊8例,纤维支气管镜联合电子胃镜确诊6例,纤维支气管镜确诊3例,胸部CT+气道三维重建确诊2例,1例外伤所致气管食管瘘系术中探查发现。除2例先天性气管食管瘘术前放弃治疗外,2例纽扣电池所致气管食管瘘采取单纯保守治疗,其余16例均行手术治疗。结果:20例患儿中,2例因经济原因术前放弃治疗,2例单纯保守治疗(1例死亡,1例失访),16例手术治愈,经胸部入路7例,经颈部入路9例;单纯气管食管瘘修补13例,气管食管瘘修补+气管重建3例,术中发现:瘘管主要位于C4-T5水平,瘘口直径约3mm-20mm。16例手术治疗患儿中8例术后恢复顺利,5例患儿术后并发气胸,经胸腔闭式引流治愈;另3例患儿并发纵隔气肿,1例经纵隔穿刺抽气治愈,另2例自行吸收。随访时间1月~9年,瘘管复发1例,经再次手术治愈;食管狭窄4例,其中2例行食管扩张治疗后明显好转,1例行食管狭窄段切除重建术好转,1例轻度狭窄不影响进食,随访好转;气管局限性狭窄及声带麻痹1例,随访好转;其余患儿恢复顺利。结论:1.儿童单纯性气管食管瘘早期诊断困难,对有进食呛咳、气促、紫绀、反复呼吸道感染的患儿需警惕单纯性气管食管瘘的可能。2.食管造影可作为单纯性气管食管瘘的首选检查方法,对诊断困难的患儿,可进一步选择纤支镜联合电子胃镜协助诊断。3.外科手术治疗儿童单纯性气管食管瘘效果良好,能耐受手术者应尽早手术治疗。4.先天性单纯性气管食管瘘只要无合并严重肺部感染,均应早期手术,术中行瘘管切断缝合可避免术后复发。对于早期不适合手术的获得性气管食管瘘患者,术前通过胃造瘘、鼻饲营养管、食管覆膜支架置入等保守治疗,有助于创造手术条件,只要一般情况好转,能耐受手术者应尽早手术,单纯保守治疗效果欠佳。
[Abstract]:Objective: to summarize the experience of clinical diagnosis and treatment of simple tracheoesophageal fistula in children. Methods: the clinical data of 20 cases of simple tracheoesophageal fistula in our hospital from February 1998 to January 2017 were analyzed retrospectively. The age ranges from 5 days to 47 months, 9 cases from June to December, 5 cases from June to December, 4 cases from 12 months to 36 months, 2 cases from 36 months, 14 cases from congenital H type tracheoesophageal fistula and 6 cases from acquired tracheoesophageal fistula, 8 cases were diagnosed by esophagography. Fiberoptic bronchoscopy combined with electronic gastroscopy was diagnosed in 6 cases and fiberoptic bronchoscopy in 3 cases. Two cases of tracheoesophageal fistula caused by tracheoesophageal fistula caused by trauma were confirmed by chest CT three-dimensional airway reconstruction. Except for 2 cases of congenital tracheoesophageal fistula, 2 cases of tracheoesophageal fistula caused by button battery were treated with simple conservative treatment except for 2 cases of congenital tracheoesophageal fistula. Results of the 20 cases, 2 cases gave up the treatment before operation because of economic reasons, 2 cases died of simple conservative treatment and 1 case died. 16 cases were cured by operation, 7 cases via chest approach and 9 cases through cervical approach. There were 13 cases of simple tracheoesophageal fistula repair and 3 cases of tracheoesophageal fistula repair. It was found that the fistula was mainly located at the level of C4-T5 during the operation. The diameter of fistula was about 3mm-20mm.16 in 8 cases, and 5 cases were complicated with pneumothorax after operation. The other 3 cases with mediastinal emphysema were cured by mediastinal puncture and exhalation, the other 2 cases were self-absorbed. The follow-up time from 1 month to 9 years was 1 case of fistula recurrence, 4 cases of esophageal stenosis, 1 case of fistula recurrence, 4 cases of esophageal stricture, 1 case of fistula recurrence, 4 cases of esophageal stricture. Two patients were treated with esophageal dilatation, one with esophageal stenosis segment resection and reconstruction, one with mild stenosis, one with improved follow-up, one with localized trachea stenosis and one with vocal cord paralysis, and one with improved tracheobronchial stenosis and vocal cord paralysis. Conclusion 1. The early diagnosis of simple tracheoesophageal fistula in children is difficult, and it is difficult to diagnose children with choking cough, shortness of breath and cyanosis. Children with recurrent respiratory tract infection should be on guard against the possibility of simple tracheoesophageal fistula. Esophagography can be used as the first choice for the examination of simple tracheoesophageal fistula. Further selection of fiberoptic bronchoscopy combined with electronic gastroscopy to assist in diagnosis .3.Surgical treatment of simple tracheoesophageal fistula in children is effective. Those who can tolerate the operation should be treated as soon as possible. (4) the congenital simple tracheoesophageal fistula should be operated early as long as there is no serious pulmonary infection. For patients with tracheoesophageal fistula who were not suitable for operation at early stage, conservative treatment such as gastrostomy, nasogastric nutrition tube and esophageal covered stent implantation could help to create surgical conditions for patients with tracheoesophageal fistula who underwent fistula incision and suture during the operation. As long as the general situation is improved, those who can tolerate the operation should be operated as soon as possible.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5

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