本文選題：單純性氣管食管瘺　切入點(diǎn)：先天性/獲得性氣管食管瘺　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:總結(jié)兒童單純性氣管食管瘺的臨床診治經(jīng)驗(yàn),提高診治水平。方法:回顧性分析我院1998年2月至2017年1月診治的20例單純性氣管食管瘺患兒的臨床病例資料,男11例,女9例;年齡范圍5天~47月,6月9例,6月-12月5例,12月-36月4例,36月2例;先天性H型氣管食管瘺14例,獲得性氣管食管瘺6例;通過食管造影確診8例,纖維支氣管鏡聯(lián)合電子胃鏡確診6例,纖維支氣管鏡確診3例,胸部CT+氣道三維重建確診2例,1例外傷所致氣管食管瘺系術(shù)中探查發(fā)現(xiàn)。除2例先天性氣管食管瘺術(shù)前放棄治療外,2例紐扣電池所致氣管食管瘺采取單純保守治療,其余16例均行手術(shù)治療。結(jié)果:20例患兒中,2例因經(jīng)濟(jì)原因術(shù)前放棄治療,2例單純保守治療(1例死亡,1例失訪),16例手術(shù)治愈,經(jīng)胸部入路7例,經(jīng)頸部入路9例;單純氣管食管瘺修補(bǔ)13例,氣管食管瘺修補(bǔ)+氣管重建3例,術(shù)中發(fā)現(xiàn):瘺管主要位于C4-T5水平,瘺口直徑約3mm-20mm。16例手術(shù)治療患兒中8例術(shù)后恢復(fù)順利,5例患兒術(shù)后并發(fā)氣胸,經(jīng)胸腔閉式引流治愈;另3例患兒并發(fā)縱隔氣腫,1例經(jīng)縱隔穿刺抽氣治愈,另2例自行吸收。隨訪時(shí)間1月~9年,瘺管復(fù)發(fā)1例,經(jīng)再次手術(shù)治愈;食管狹窄4例,其中2例行食管擴(kuò)張治療后明顯好轉(zhuǎn),1例行食管狹窄段切除重建術(shù)好轉(zhuǎn),1例輕度狹窄不影響進(jìn)食,隨訪好轉(zhuǎn);氣管局限性狹窄及聲帶麻痹1例,隨訪好轉(zhuǎn);其余患兒恢復(fù)順利。結(jié)論:1.兒童單純性氣管食管瘺早期診斷困難,對有進(jìn)食嗆咳、氣促、紫紺、反復(fù)呼吸道感染的患兒需警惕單純性氣管食管瘺的可能。2.食管造影可作為單純性氣管食管瘺的首選檢查方法,對診斷困難的患兒,可進(jìn)一步選擇纖支鏡聯(lián)合電子胃鏡協(xié)助診斷。3.外科手術(shù)治療兒童單純性氣管食管瘺效果良好,能耐受手術(shù)者應(yīng)盡早手術(shù)治療。4.先天性單純性氣管食管瘺只要無合并嚴(yán)重肺部感染,均應(yīng)早期手術(shù),術(shù)中行瘺管切斷縫合可避免術(shù)后復(fù)發(fā)。對于早期不適合手術(shù)的獲得性氣管食管瘺患者,術(shù)前通過胃造瘺、鼻飼營養(yǎng)管、食管覆膜支架置入等保守治療,有助于創(chuàng)造手術(shù)條件,只要一般情況好轉(zhuǎn),能耐受手術(shù)者應(yīng)盡早手術(shù),單純保守治療效果欠佳。
[Abstract]:Objective: to summarize the experience of clinical diagnosis and treatment of simple tracheoesophageal fistula in children. Methods: the clinical data of 20 cases of simple tracheoesophageal fistula in our hospital from February 1998 to January 2017 were analyzed retrospectively. The age ranges from 5 days to 47 months, 9 cases from June to December, 5 cases from June to December, 4 cases from 12 months to 36 months, 2 cases from 36 months, 14 cases from congenital H type tracheoesophageal fistula and 6 cases from acquired tracheoesophageal fistula, 8 cases were diagnosed by esophagography. Fiberoptic bronchoscopy combined with electronic gastroscopy was diagnosed in 6 cases and fiberoptic bronchoscopy in 3 cases. Two cases of tracheoesophageal fistula caused by tracheoesophageal fistula caused by trauma were confirmed by chest CT three-dimensional airway reconstruction. Except for 2 cases of congenital tracheoesophageal fistula, 2 cases of tracheoesophageal fistula caused by button battery were treated with simple conservative treatment except for 2 cases of congenital tracheoesophageal fistula. Results of the 20 cases, 2 cases gave up the treatment before operation because of economic reasons, 2 cases died of simple conservative treatment and 1 case died. 16 cases were cured by operation, 7 cases via chest approach and 9 cases through cervical approach. There were 13 cases of simple tracheoesophageal fistula repair and 3 cases of tracheoesophageal fistula repair. It was found that the fistula was mainly located at the level of C4-T5 during the operation. The diameter of fistula was about 3mm-20mm.16 in 8 cases, and 5 cases were complicated with pneumothorax after operation. The other 3 cases with mediastinal emphysema were cured by mediastinal puncture and exhalation, the other 2 cases were self-absorbed. The follow-up time from 1 month to 9 years was 1 case of fistula recurrence, 4 cases of esophageal stenosis, 1 case of fistula recurrence, 4 cases of esophageal stricture, 1 case of fistula recurrence, 4 cases of esophageal stricture. Two patients were treated with esophageal dilatation, one with esophageal stenosis segment resection and reconstruction, one with mild stenosis, one with improved follow-up, one with localized trachea stenosis and one with vocal cord paralysis, and one with improved tracheobronchial stenosis and vocal cord paralysis. Conclusion 1. The early diagnosis of simple tracheoesophageal fistula in children is difficult, and it is difficult to diagnose children with choking cough, shortness of breath and cyanosis. Children with recurrent respiratory tract infection should be on guard against the possibility of simple tracheoesophageal fistula. Esophagography can be used as the first choice for the examination of simple tracheoesophageal fistula. Further selection of fiberoptic bronchoscopy combined with electronic gastroscopy to assist in diagnosis .3.Surgical treatment of simple tracheoesophageal fistula in children is effective. Those who can tolerate the operation should be treated as soon as possible. (4) the congenital simple tracheoesophageal fistula should be operated early as long as there is no serious pulmonary infection. For patients with tracheoesophageal fistula who were not suitable for operation at early stage, conservative treatment such as gastrostomy, nasogastric nutrition tube and esophageal covered stent implantation could help to create surgical conditions for patients with tracheoesophageal fistula who underwent fistula incision and suture during the operation. As long as the general situation is improved, those who can tolerate the operation should be operated as soon as possible.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.5

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