胸腔镜下 H 型气管食管瘘闭合术：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports Pub Date : 2024-10-24 DOI:10.1016/j.epsc.2024.102910

Kazuo Oshima , Yujiro Tanaka , Keisuke Suzuki , Chizuka Seki , Mina Yoshida , Hiroaki Komuro

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引用次数: 0

摘要

病例介绍一名女性新生儿在妊娠31周时早产，体重1200克。后来，她被诊断为 CHARGE 综合征。出生后不久即开始鼻胃管喂养。鼻胃管中有气泡冒出，怀疑是气管食管瘘（TEF）。对比食管造影证实，在第二胸椎体水平有一个 h 型 TEF。患者五个月大、体重 3 千克时，被送往手术室进行胸腔镜下 TEF 修复术。她被置于完全左侧卧位。在右侧胸腔放置了四个 5 毫米的孔。确定了右侧迷走神经。我们首先用纵隔胸膜制作了一个胸膜瓣。对食管和气管进行钝性剥离后，可以清楚地识别 TEF。在 TEF 周围放置一个血管环。分割 TEF。用间断缝合法缝合 TEF 的食管端和气管端。胸膜瓣被放置在两个残端之间。手术耗时 238 分钟。术后恢复顺利，TEF没有复发。一个月后，她接受了气管造口术，三个月后又接受了腹腔镜胃底折叠术。结论胸腔镜似乎是修复高位胸腔 h 型 TEF 的合适方法。

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Thoracoscopic closure of an H-type tracheoesophageal fistula: A case report

Introduction

Isolated h-type tracheoesophageal fistula (H-TEF) without esophageal discontinuity is rare and poses challenges in selecting a surgical approach due to the height of the fistula within the thoracic cavity.

Case presentation

A female neonate was born prematurely at 31 weeks of gestation with a weight of 1200 g. She was intubated at birth due to respiratory distress. She was later diagnosed with CHARGE syndrome. Nasogastric tube feedings were initiated shortly after birth. Air bubbles could be seen coming out the nasogastric tube, which were suspicious for a tracheoesophageal fistula (TEF). A contrast esophagogram confirmed an h-type TEF at the level of the second thoracic vertebral body. When the patient was five months old and had a weight of 3 Kg, she was taken to the operating room for a thoracoscopic repair of the TEF. She was placed in complete left lateral position. Four 5-mm ports were placed in the right hemithorax. The right vagus nerve was identified. We first created a pleural flap with the mediastinal pleura. Blunt dissection of the esophagus and the trachea allowed clear identification of the TEF. A vessel loop was placed around the TEF. The TEF was divided. The esophageal end the tracheal sides of the TEF were closed with interrupted stitches. The pleural flap was interposed between the two stumps. The operation took 238 minutes. The postoperative period was uneventful, and she had no recurrence of the TEF. She underwent a tracheostomy one month later, and a laparoscopic fundoplication three months after that. She was discharged home at one year of age.