小儿先天性H型气管食管瘘的诊断与治疗

目的总结先天性H型气管食管瘘的诊治经验。方法收集本院近10年来收治的8例先天性H型气管食管瘘患儿临床资料,其中男性5例,女性3例,通过食管造影确诊5例,胸部CT±气道重建确诊1例,纤维支气管镜确诊1例,瘘管切断缝合术6例。结果 8例均手术治疗痊愈,1例术后第4天出现气胸、纵隔气肿,经保守治疗痊愈。随访3个月至9年,1例术后1个月复发,经再次手术治疗痊愈。结论先天性H型气管食管瘘诊断困难,对临床表现可疑者可通过多种检查方式获得诊断,瘘管切断缝合术可取得良好的治疗效果。

Diagnosis and treatment of congenital H-type tracheoesophageal fistula:a report of 8 cases

Objective To summarize the experiences of diagnosing and treating congenital H-type tra-cheoesophageal fistula (H—TEF). Methods Eight cases of H—TEF were recruited and examined over the past decade. The diagnosis was confirmed by esophageal radiography,bronchoscopy,electronic gastroscope and reconstruction of three-dimensional imaging of chest CT alone or in combination. Then surgery was performed through cervical(n=5)and thoracic(n=3)approaches.The procedures were fistula ligation(n=2)and fistu-la excision suture (n=6). Results All patients were cured surgically. At Day 4 post-operation,one case of pneumothorax and mediastinal emphysema was cured conservatively. The remainder recovered and discharged uneventfully. During a follow-up period of 3 months to 9 years,except for one case of postoperative recurrence, the remainder recovered smoothly with the disappearances of cough,cyanosis and polypnea. There was no re-currence of H—TEF. Conclusions An early diagnosis of congenital H—TEF is rather difficult. H—type TEF may be diagnosed through various examinations alone or in combination. Fistula excision suturing is efficacious.