Abstract：
OBJECTIVE: Tracheoesophageal fistula (TEF) is characterized by abnormal connectivity between the posterior wall of the trachea or bronchus and the adjacent anterior wall of the oesophagus. Benign TEF can result in serious complications; however, there is currently no uniform standard to determine the appropriate surgical approach for repairing TEF.
METHODS: The PubMed database was used to search English literature associated with TEF from 1975 to October 2023. We employed Boolean operators and relevant keywords: \'tracheoesophageal fistula\', \'tracheal resection\', \'fistula suture\', \'fistula repair\', \'fistula closure\', \'flap\', \'patch\', \'bioabsorbable material\', \'bioprosthetic material\', \'acellular dermal matrix\', \'AlloDerm\', \'double patch\', \'oesophageal exclusion\', \'oesophageal diversion\' to search literature. The evidence level of the literature was assessed based on the GRADE classification.
RESULTS: Nutritional support, no severe pulmonary infection and weaning from mechanical ventilation were the 3 determinants for timing of operation. TEFs were classified into 3 levels: small TEF (<1 cm), moderate TEF (≥1 but <5 cm) and large TEF (≥5 cm). Fistula repair or tracheal segmental resection was used for the small TEF with normal tracheal status. If the anastomosis cannot be finished directly after tracheal segmental resection, special types of tracheal resection, such as slide tracheoplasty, oblique resection and reconstruction, and autologous tissue flaps were preferred depending upon the site and size of the fistula. Oesophageal exclusion was applicable to refractory TEF or patients with poor conditions.
CONCLUSIONS: The review primarily summarizes the main surgical techniques employed to repair various acquired TEF, to provide references that may contribute to the treatment of TEF.
METHODS: The PubMed database was used to search English literature associated with TEF from 1975 to October 2023. We employed Boolean operators and relevant keywords: \'tracheoesophageal fistula\', \'tracheal resection\', \'fistula suture\', \'fistula repair\', \'fistula closure\', \'flap\', \'patch\', \'bioabsorbable material\', \'bioprosthetic material\', \'acellular dermal matrix\', \'AlloDerm\', \'double patch\', \'oesophageal exclusion\', \'oesophageal diversion\' to search literature. The evidence level of the literature was assessed based on the GRADE classification.
RESULTS: Nutritional support, no severe pulmonary infection and weaning from mechanical ventilation were the 3 determinants for timing of operation. TEFs were classified into 3 levels: small TEF (<1 cm), moderate TEF (≥1 but <5 cm) and large TEF (≥5 cm). Fistula repair or tracheal segmental resection was used for the small TEF with normal tracheal status. If the anastomosis cannot be finished directly after tracheal segmental resection, special types of tracheal resection, such as slide tracheoplasty, oblique resection and reconstruction, and autologous tissue flaps were preferred depending upon the site and size of the fistula. Oesophageal exclusion was applicable to refractory TEF or patients with poor conditions.
CONCLUSIONS: The review primarily summarizes the main surgical techniques employed to repair various acquired TEF, to provide references that may contribute to the treatment of TEF.
摘要：
目的：气管食管瘘（TEF）的特征是气管或支气管的后壁与邻近的食管前壁之间的连接异常。良性TEF可导致严重的并发症；然而，目前尚无统一标准来确定合适的TEF修复手术方式.
方法：PubMed数据库用于搜索1975年至2023年10月与TEF相关的英语文献。我们使用布尔运算符和相关关键词：“气管食管瘘”，“气管切除术”，“瘘管缝合术”，\"瘘管修复\",“瘘管闭合”，\"襟翼\",\"修补程序\",“生物可吸收材料”，“生物假体材料”，“脱细胞真皮基质”，\"AlloDerm\",\"双补丁\",“食管排斥”，“食管改道”检索文献。根据GRADE分类评估文献的证据水平。
结果：营养支持，无严重肺部感染,机械通气和断奶是决定手术时机的三个因素。TEF分为三个级别：小TEF(<1cm)，中度TEF（≥1但<5cm），和大TEF（≥5cm）。气管状态正常的小TEF采用瘘修复或气管段切除术。如果气管段切除后不能直接完成吻合，特殊类型的气管切除，比如滑动气管成形术,斜切除和重建，根据瘘管的部位和大小，首选自体组织瓣。食管排斥适用于难治性TEF或病情较差的患者。
结论：本综述主要总结了用于修复各种获得性TEF的主要手术技术，为TEF的治疗提供参考。
方法：PubMed数据库用于搜索1975年至2023年10月与TEF相关的英语文献。我们使用布尔运算符和相关关键词：“气管食管瘘”，“气管切除术”，“瘘管缝合术”，\"瘘管修复\",“瘘管闭合”，\"襟翼\",\"修补程序\",“生物可吸收材料”，“生物假体材料”，“脱细胞真皮基质”，\"AlloDerm\",\"双补丁\",“食管排斥”，“食管改道”检索文献。根据GRADE分类评估文献的证据水平。
结果：营养支持，无严重肺部感染,机械通气和断奶是决定手术时机的三个因素。TEF分为三个级别：小TEF(<1cm)，中度TEF（≥1但<5cm），和大TEF（≥5cm）。气管状态正常的小TEF采用瘘修复或气管段切除术。如果气管段切除后不能直接完成吻合，特殊类型的气管切除，比如滑动气管成形术,斜切除和重建，根据瘘管的部位和大小，首选自体组织瓣。食管排斥适用于难治性TEF或病情较差的患者。
结论：本综述主要总结了用于修复各种获得性TEF的主要手术技术，为TEF的治疗提供参考。
