王斌 气管食管瘘.ppt

LOGO Tracheoesophageal Fistula 气管食管瘘 王 斌 Case A 12-hour-old full term infant， weighing 2.5 kg presents with choking（窒息） and cyanosis （发绀） during its first feed. Neonatal （新生儿） intensive care unit (NICU) staff is unable to pass a feeding tube into the stomach. The baby also has copious（大量的） oral secretions （分泌物）. Before birth polyhydramnios （羊水过多） was seen. 1. What are the clinical features of TEF? This patient has esophageal atresia(食管闭锁) with tracheoesophageal fistula（TEF）. This occurs in 1 per 4,000 live births. The diagnosis is suspected prenatally（产前） by the presence of polyhydramnios caused by failure of the fetus(胎儿) to swallow amniotic fluid（羊水） (secondary to esophageal atresia). After birth, the neonate will have copious drooling（流涎）. Attempting to feed the baby will result in coughing and cyanosis. An orogastric tube (口胃管) will coil up in the upper esophageal pouch（盲端） rather than pass into the stomach. 2. What is the pathophysiology of TEF? In this abnormality the distal(远端，末梢) trachea（气管） is connected to the lower esophagus（食管） through a fistula. This causes three problems. First, inhaled air can bypass the lungs and distend（膨胀） the stomach, which will eventually impede ventilation and cause atelectasis（肺不张）. Second, acidic stomach contents are at continual risk of leaking back into and damaging lung tissue. Third, oral secretions tend to pool（聚集） in the proximal（近端） esophageal pouch resulting in intermittent aspiration, coughing, and cyanosis. 3. How does this lesion occur during development? The median ventral diverticulum（腹侧正中憩室） of the foregut(前肠) differentiates into a separate（隔） esophagus and trachea by the end of the fifth week of gestation（怀孕）. The fistula comes from respiratory