背景:气道异常,症状和干预措施在食管闭锁伴气管食管瘘(OA/TOF)患儿中常见.这项研究的目的是评估这些气道病变的发生率以及需要长期干预的发生率。
方法:对皇家儿童医院新生儿病房收治的所有患者进行回顾性病例回顾,格拉斯哥在2000年1月至2015年12月期间诊断为OA/TOF。纳入的患者至少随访5年。
结果:确定了121例患者。118进行OA/TOF维修。115例患者有长期随访数据。95(83%)儿童有一个或多个气道症状记录。36例(31%)新生儿在初次OA/TOF修复时接受了气道内窥镜检查。由于气道症状,46名(40%)儿童在以后接受了气道内窥镜检查。确定的气道病理包括气道软化,32(28%),声门下狭窄,十一(10%),气管袋,二十五(22%),喉裂,7(6%)和复发性瘘,五(4%)。气道干预包括气管囊的内窥镜分割,十(9%),气管造口术,七(6%),主动脉固定术,六(5%),复发性瘘修复术,五个(4%),喉裂内镜修复术,3例(3%)和4例(3%)需要开放气道重建治疗声门下狭窄.1名儿童(1%)仍依赖气管造口术。
结论:长期气道病变常见于OA/TOF患儿。其中许多可以通过手术干预来补救。临床医生应该认识到这一点,并适当地参考AirwayServices。
BACKGROUND: Airway anomalies, symptoms and interventions are commonly reported in children with oesophageal atresia with tracheoesophageal fistula (OA/TOF). The purpose of this
study was to assess the incidence of these airway pathologies and those requiring interventions in the long-term.
METHODS: A retrospective case note review of all patients admitted to the Neonatal Unit at the Royal Hospital for Children, Glasgow between January 2000 and December 2015 diagnosed with OA/TOF. Included patients had a minimum of 5 years follow-up.
RESULTS: 121 patients were identified. 118 proceeded to OA/TOF repair. 115 patients had long-term follow-up data. Ninety-five (83%) children had one or more airway symptom recorded. Thirty-six (31%) neonates underwent airway endoscopy at the time of their initial OA/TOF repair. Forty-six (40%) children underwent airway endoscopy at a later date due to airway symptoms. Airway pathologies identified included airway malacia, thirty-two (28%), subglottic stenosis, eleven (10%), tracheal pouch, twenty-five (22%), laryngeal cleft, seven (6%) and recurrent fistula, five (4%). Airway interventions included endoscopic division of tracheal pouch, ten (9%), tracheostomy, seven (6%), aortopexy, six (5%), repair of recurrent fistula, five (4%), endoscopic repair of laryngeal cleft, three (3%) and four (3%) required open airway reconstruction for subglottic stenosis. One child (1%) remains tracheostomy dependent.
CONCLUSIONS: Long-term airway pathologies are common in children with OA/TOF. Many of these are remediable with surgical intervention. Clinicians should be cognisant of this and refer to Airway Services appropriately.