CAJ | 학술논문

目的探讨多学科镶嵌治疗对儿童气管食管瘘(tracheoesophageal fistula,TEF)的治疗效果.方法 2008年4月至2011年10月,我院收治气管食管瘘患儿4例,均为女性,其中H型气管食管瘘2例,气管食管瘘手术后瘘管复发2例.手术中均在消化科、呼吸科和外科协作下,首先通过胃镜注射美蓝,经支气管镜观察美蓝初步判定瘘管的位置,之后将导引钢丝从气管镜内经瘘管导入食管内,利用胃镜活检钳将导引钢丝牵出空腔外,X线下观察到导丝经过瘘管在气管和食道间形成环路,然后根据瘘管位置决定手术切口和手术入路进行手术缝扎.结果本组4例均在通过胃镜、支气管镜联合辅助下,采用“导丝环”定位方法对瘘管进行快速、准确定位,外科均成功缝扎瘘管,随访无瘘管复发.结论术中多学科镶嵌治疗有利于气管食管瘘瘘管准确定位,保证手术顺利有效进行和成功纠治,是治疗儿童气管食管瘘的新模式.
목적 탐토다학과양감치료대인동기관식관루(tracheoesophageal fistula,TEF)적치료효과.방법 2008년4월지2011년10월,아원수치기관식관루환인4례,균위녀성,기중H형기관식관루2례,기관식관루수술후루관복발2례.수술중균재소화과、호흡과화외과협작하,수선통과위경주사미람,경지기관경관찰미람초보판정루관적위치,지후장도인강사종기관경내경루관도입식관내,이용위경활검겸장도인강사견출공강외,X선하관찰도도사경과루관재기관화식도간형성배로,연후근거루관위치결정수술절구화수술입로진행수술봉찰.결과 본조4례균재통과위경、지기관경연합보조하,채용“도사배”정위방법대루관진행쾌속、준학정위,외과균성공봉찰루관,수방무루관복발.결론 술중다학과양감치료유리우기관식관루루관준학정위,보증수술순리유효진행화성공규치,시치료인동기관식관루적신모식.
Objective To explore an innovative technique that is aided by multi-disciplinary hybrid approach in identification and treatment of tracheoesophageal fistula ( TEF ) in children intraoperatively.Method From April 2008 to October 2011,4 patients with isolated TEF were presented with 2 H-type fistulas and 2 recurrent TEF.For all the four cases,with the cooperation of.the gastroenterologists,respiratory physician and surgeon,methylene blue was first injected into the trachea for detecting the dye in the esophagus by the gastroscopy.Bronehoscopy was performed where the fistula tract was shown by the methylene blue and a guide wire was passed through the fistula.The patients underwent rigid gastroscopy and the guide wire was identified and brought out through the mouth by biopsy pliers.This created a wire loop through the fistula.X-ray was then used to identify the level of the fistula.According to the level of the fistula it was determined whether surgical incision and approach should be used.The fistula was then repaired successfully by surgery.Result In the 4 patients,with the aid of gastroscopy and bronchoscopy,identification of the fistula intraoperatively was then facilitated by traction on the loop.The fistula was identified and repaired.There were no fistula recurrences.Conclusion Multi-disciplinary hybrid therapy for tracheoesophageal fistula in children is beneficial for the precise localization of the fistula.This new technique is an effective and definitive method in identification and treatment of TEF in children.