摘要
Background Despite improvements in the treatment of esophageal atresia with tracheoesophageal fistula(TEF)in recent decades,complications still exist.The rate of fistula recanalization after surgical repair is~5%in large cohorts.However,there is controversy regarding the gold standard of treatment.This research aimed to evaluate the efficacy of treatment of pediatric patients with isolated(H-type)and recurrent TEF in our clinic.Methods We retrospectively analyzed 12 patients(7 boys,5 girls)aged 35 days-14.6 years.The median age of our patients was 632 days[95%CI(confident interval)120.1 to 2118.7];the mean birth weight was 2713 g(95%CI 2258 to 3169;median:2763 g);and the mean gestational age was 37.1 weeks(95%CI 35.4 to 38.8;median:37 weeks).All patients were managed for isolated or recurrent TEF between January 1,2015 and December 31,2020 using endoscopy(laser de-epithelialization).Results Laser de-epithelialization alone was effective in 8 of 12 patients(66.67%),with a mean number of de-epithelializations of 2.25(range:1-4).After one attempt at de-epithelialization,success was achieved in only two patients(n=16.67%).The mortality rate was 0%.The median follow-up for patients who received endoscopic treatment exclusively(n=8)was 3.7 years(95%CI 1.38 to 4.87)after the last stage of de-epithelialization.Conclusion Flexible endoscopy is an alternative treatment to open surgical repair of isolated and recurrent TEF in children.The effectiveness of endoscopic laser de-epithelialization alone with subsequent fistula obliteration was 66.7%,with a median follow-up of 3.7 years.
