کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
4154669 1411249 2016 4 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Cervical repair of congenital tracheoesophageal fistula: Complications lurking! ★★★
ترجمه فارسی عنوان
ترمیم Cervical فیستول tracheoesophageal مادرزادی: عوارض حیرت انگیز!
کلمات کلیدی
آترزی مری؛ فیستول tracheoesophageal جدا شده؛ TEF
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی پریناتولوژی (پزشکی مادر و جنین)، طب اطفال و بهداشت کودک
چکیده انگلیسی

AimEsophageal atresia (EA) and tracheoesophageal fistula (TEF) consist of a spectrum of rare congenital abnormalities. Although EA surgical treatment is well established, the outcome of EA with proximal fistula (type B and D EA) or isolated H-type fistula (type E EA) is poorly explored. These forms of EA shared a common surgical step: the need of a cervical approach to close the fistula. Therefore, the aim of present study is to evaluate postoperative outcomes of patients treated for Gross type B–D and E EA, on regards of their cervical surgery.Materials and methodsA retrospective case series analysis of all patients affected by type B–D and E EA, and admitted to our tertiary care center between January 2003 and December 2014 was performed. All patients underwent preoperative flexible laryngo-tracheobronchoscopy (LTBS) as part of our standardized preoperative diagnostic assessment to define the diagnosis, evaluate preoperative vocal cord motility and to cannulate the fistula when required. Fistula closure was always performed through a right cervical access. Analysis of all cases and comparison between type B–D and E EA were performed. Mann–Whitney test, Chi-squared test and unpaired t test were used as appropriate; p < 0.05 was considered significant.ResultsDuring the study period, 180 EA newborns were treated. Proximal or isolated TEF was found in 18 patients (10%): 7 type B, 11 type E EA. Patients affected by type B and E EA/TEF frequently present associated major malformations (27%), and major cardiac abnormalities (44%). Major postoperative complications were: vocal cord paralysis (5 patients), bilateral in 2 infants requiring tracheostomy, cerebral ischemia (1 patient), and cardiac failure (1 patient).ConclusionPatients affected by type B and E EA have a high rate of associated abnormalities, and risk of possible sequelae. Postoperative complications are common, with possible transient vocal cord dismotility, but in some cases persistent paralysis may require tracheostomy. Therefore, both preoperative and postoperative LTBS is highly recommended to evaluate the presence of a proximal fistula, and vocal cord motility, even in asymptomatic patients, to rule out any possible intraoperative “surprise” and any vocal cord abnormality and to possibly define its pathogenesis (congenital vs. iatrogenic).

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of Pediatric Surgery - Volume 51, Issue 10, October 2016, Pages 1623–1626
نویسندگان
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