Ⅲ型先天性食管闭锁合并气管软化的早期诊断及临床结局分析

Early diagnosis and clinical outcome analysis of type Ⅲ congenital esophageal atresia with tracheomalacia

目的探讨Ⅲ型先天性食管闭锁(congenital esophageal atresia,CEA)合并气管软化(tracheomalacia,TM)的早期诊断方法及临床结局,为CEA合并TM提供临床诊疗经验。方法收集2019年11月至2020年9月广州市妇女儿童医疗中心新生儿外科重症监护病房收治且术前进行电子支气管内窥镜检查的Ⅲ型CEA患者临床资料,对其中15例食管修复术前及术后行电子支气管镜检查患者的气道评估结果及临床结局进行回顾性分析。结果15例患者中男12例,女3例;出生胎龄(34~40.6)周,中位出生胎龄38.3周;7例(46.7%)存在食管狭窄,5例(33.3%)影像学检查提示胃食管反流;14例(93.3%)合并TM(2例为轻度,10例为中度,2例为重度),8例术后1个月再次评估TM较术前更明显,3例为中度TM,5例为重度TM。4例(26.67%)术后无症状;11例(73.33%)表现为痰鸣、呛咳、发绀、气促、拒奶、窒息等,其中2例发生进食后窒息经抢救成功。随访期间无一例食管气管瘘复发,无吻合口漏及食管裂孔疝发生。结论TM是CEA常见合并症,是CEA手术后呼吸道相关症状发生率高的重要原因,电子支气管镜检查可早期诊断和评估TM,以指导临床治疗。TM可能导致危及生命的事件,建议长期进行呼吸道随访,以及时救治。

Objective To explore the early diagnosis and clinical outcome of typeⅢcongenital esophageal atresia(CEA)with tracheomalacia(TM),and to provide clinical reference for CEA with TM.Methods In the retrospective study,the clinical data of 15 cases with typeⅢCEA from November 2019 to December 2020 in Guangzhou Women and Children s Medical Center were collected,and preoperative and postoperative airway assessment results based on endoscopy were analyzed.Results A total of 31 CEA cases were treated in our hospital,15 cases assessed by pre-endoscopy were enrolled in this study,including 12 males and 3 females.The median gestational age was 38.3(34~40.6)weeks.Among them,14(93.3%)cases complicated by TM including 2 cases with mild TM,10 cases with moderate TM,and 2 cases with severe TM.In 8 cases,TM was more pronounced than preoperative TM when reassessed 1 month after surgery,including 3 cases with moderate TM and 5 cases with severe TM.Among 15 cases,7 cases(46.7%)were diagnosed stricture,and 5 cases(33.3%)with gastroesophageal reflux diagnosed by image inspection.4 cases(26.67%)showed no symptoms after surgery,11 cases(73.33%)presented with respiratory symptoms,and 2 of them underwent acute life-threatening events and both were successfully rescued.Conclusion TM are frequently associated with CEA and represent an important etiology of high morbidity and mortality of CEA.Electronic bronchoscopy can be used for early diagnosis and evaluation of TM.Life-threatening events may occur in TM patients,and long-term respiratory tract follow-up is recommended in order to get timely rescue.