背景:先天性气管食管瘘(TEF)是一种罕见的发育畸形。H亚型约占TEF的4%。与其他TEF不同,H型不伴有食管闭锁,具有非特异性临床症状,其特定的解剖学异常并不总是显而易见的。此外,目前可用的H型TEF诊断方法都没有绝对的灵敏度,导致误诊,准确的诊断通常会延迟到成年;在我们的案例中,我们发现了先天性支气管食管瘘,比普通H型TEF更为罕见,通过一种以前没有报道过的新生儿技术,涉及支气管镜检查,用食管镜注射亚甲蓝.我们相信我们已经在新生儿中首先提供了这种情况。此外,因为到目前为止还没有一篇文献总结临床症状和有效的方法,我们仍然不清楚哪种侦查方法更有效或更准确,尤其是新生儿,因此,总结和比较对于提高TEF的早期诊断是非常必要的;我们的研究对文献做出了重大贡献,因为我们整理了以前报道的病例,包括临床特征以及主要测试的有用性和成功率,这将有助于TEF的早期诊断。
方法:一名新生儿男性从出生时就出现一系列非特异性临床症状,导致肺炎和机械通气。口服喂养导致大多数但不是所有症状的改善,当恢复口服喂养时返回。第二轮验证性测试仍无法发现原因。
方法:H型支气管食管瘘的诊断是通过一种以前未报道新生儿的技术建立的,涉及支气管镜检查,用食管镜注射亚甲蓝.
方法:诊断后进行手术,成功修复了支气管食管瘘。
结果:患者在术后第7天出院,在术后8个月的随访中报告其状态正常。
结论:H型TEF是一种罕见的先天性畸形,它的早期诊断非常困难,尤其是支气管食管瘘.口腔唾液增加和充满空气的胃是特征性表现。支气管镜联合食管镜能提高早期诊断率。测试的组合可以提高检测率。
BACKGROUND: Congenital tracheoesophageal fistula (TEF) is a rare developmental malformation. The H subtype accounts for approximately 4% of TEFs. Unlike other TEFs, the H-type is not accompanied by esophageal atresia and has nonspecific clinical symptoms, and its specific anatomical abnormalities are not always readily apparent. Furthermore, none of the currently available diagnostic methods for H-type TEF have absolute sensitivity, resulting in misdiagnoses, and accurate diagnoses are often delayed even until adulthood; in our case, we detected a congenital bronchoesophageal fistula, which is even more rare than regular H-type TEF, through a technique that was not previously reported for newborns, involving bronchoscopy, with methylene blue injected through an esophagoscope. We believe that we have provided this kind of case first in newborns.Furthermore, because there is not one literature summarizing the clinical symptoms and the effective methods up to now, we still are not clear which detective method is more efficient or accurate, especially in newborns, so it is very necessary to summarize and compare for improving the early diagnosis of TEFs; our study makes a significant contribution to the literature because we collated previously reported cases, including the clinical features and the usefulness and success rates of major tests, which will be very helpful for the early diagnosis of TEFs.
METHODS: A newborn male presented with an array of nonspecific clinical symptoms from birth, leading to pneumonia and mechanical ventilation. Oral feeding led to an improvement in most but not all symptoms, which returned when oral feeding was resumed. A second round of confirmatory tests was still unable to detect the cause.
METHODS: The diagnosis of H-type bronchoesophageal fistula was established through a technique that was not previously reported for newborns, involving bronchoscopy, with methylene blue injected through an esophagoscope.
METHODS: The surgery was performed after diagnosis, and the bronchoesophageal fistula was successfully repaired.
RESULTS: The patient was discharged on postoperative day 7, and his status was reported to be normal at a follow-up visit 8 months after surgery.
CONCLUSIONS: H-type TEF is a rare congenital abnormality, and its early diagnosis is highly difficult, especially bronchoesophageal fistula. Increased oral saliva and air-filled stomachs are characteristic manifestations. Bronchoscopy combined with esophagoscopy can improve the rate of early diagnosis. A combination of tests can improve the detection rate.