儿童食管异物致继发性食管气管瘘临床内镜表现及处理

Endoscopic features and management of acquired tracheoesophageal fistula caused by esophageal foreign bodies in children

目的探讨儿童食管异物致继发性食管气管瘘(TEF)的临床特点、内镜表现及处理方法。方法回顾性分析2008年1月至2019年1月郑州大学附属儿童医院治疗的21例继发性TEF患儿的临床资料,统计异物类型、瘘管并发症、处理方法及临床预后。结果21例食管异物主要为扣式电池(7例,33.33%)、枣核(4例,19.05%)、不规则铁片(3例,14.29%)、动物骨片(3例,14.29%)、游戏币(2例,9.52%)、鱼刺(2例,9.52%);异物均于内镜下取出,术中发现食管穿孔并TEF 17例(80.95%),术后2周内食管穿孔并TEF 4例(19.05%),无死亡病例。瘘口大小;瘘口≤5 mm者13例(61.90%),瘘口>5 mm及≤10 mm者4例(19.05%),瘘口>10 mm者4例(19.05%)。处理方式:胃管引流及鼻空肠营养管支持治疗10例(47.61%),胃造瘘及空肠造瘘营养管支持治疗4例(19.05%),外科手术修补4例(19.05%),内镜下钛夹缝合3例(14.29%)。愈合时间:3个月5例(23.81%),5个月6例(28.57%),8个月4例(19.05%),12个月2例(9.52%)。结论儿童继发性TEF因特殊异物嵌顿压迫食管所致,内镜下微创技术创伤小且有效,应尽早采取适当的手术方式及干预处理。

Objective To investigate the clinical characteristics,endoscopic features and management of acquired tracheoesophageal fistula(TEF)by esophageal foreign bodies in children.Methods The clinical data and follow-up data of 21 children with acquired TEF who were treated in Children′s Hospital Affiliated to Zhengzhou University from January 2008 to January 2019 were retrospectively analyzed.Results A total of 21 cases with esophageal foreign bodies were button batteries,irregular iron sheets,game coins,jujube seed,animal bone sheets,and fish thorn.The statistical results suggested that the cases of button batteries were 7 cases(33.33%),4 cases of jujube pit(19.05%),3 cases of irregular iron(14.29%)and 3 cases of animal bone(14.29%),2 cases of game coin(9.52%),2 cases of fish thorn(9.52%).All foreign bodies were removed by endoscopy.Esophageal perforation with TEF was discovered in 17 cases(80.95%)during the operation.Esophageal perforation with TEF was found in 4 cases(19.05%)within 2 week after the operation,and no death occurred.A total of 13 case fistula size≤5 mm(61.90%),4 case fistula size>5 mm and≤10 mm(19.05%)and 4 case fistula size>10 mm(19.05%).The treatment methods included gastrointestinal decompression and nasojejunal nutrition tube support in 10 cases(47.61%),gastrostomy and jejunostomy in 4 cases(19.05%),surgical repair in 4 cases(19.05%)and endoscopic titanium clip suture in 3 cases(14.29%).Five cases(23.81%)were healed in 3 months,6 cases(28.57%)in 5 months,4 cases(19.05%)in 8 months,and 2 cases(9.52%)in 12 months.Conclusions Acquired TEF in children are mostly caused by special foreign bodies embedded in the esophagus,and endoscopic management is effective for fistulas with less trauma.Appropriate operation and intervention should be taken as early as possible.