Objective To investigate the clinical characteristics of children with double H-type congenital tracheoesophageal fistulas(DCTEFs).Methods Two cases of DCTEFs(patient 1 and 2)treated at Xi'an Children's Hospital were selected in this study.A retrospective analysis was conducted to examine the clinical data,diagnostic methods,and treatment plans for these two patients.Literature searches were performed in Chinese databases such as CNKI and Wanfang using Chinese keywords including"tracheoesophageal fistula""H-type tracheoesophageal fistula""double tracheoesophageal fistula""double H-type tracheoesophageal fistula""Ⅴ-type esophageal atresia""simple tracheoesophageal fistula"and"esophageal tracheal fistula".Additionally,English databases in PubMed and Embase were searched using English keywords such as"tracheoesophageal fistula""H-type tracheoesophageal fistula""double H-type tracheoesophageal fistula""double tracheoesophageal fistula"and"Ⅴ-type esophageal atresia".The search period was set from January 1952 to November 2022.Results ① Patient 1(4 months and 2 days old)was admitted to our hospital on August 29,2018,with symptoms of choking on milk,vomiting,and recurrent respiratory infections after birth.Patient 2(2 years and 11 months old)was admitted on March 24,2020,with symptoms of choking cough,vomiting,and recurrent respiratory infections after birth.Both patients underwent bronchoscopy and were found to have two H-type tracheoesophageal fistulas.They both underwent endoscopic tracheoesophageal fistula closure(TFC),with argon beam coagulation of the mucosa around the inner fistula of the esophagus.Patient 1 was cured,while patient 2 experienced a recurrence 8 months after surgery.② According to the search strategies established in this study,a total of 10 relevant articles were retrieved,involving 10 cases with DCTEFs.Among them,7 patients(patients 4,6-10,12)had relatively complete clinical case data,all showing respiratory and gastrointestinal symptoms,such as cyanosis after feeding,choking cough,vomiting,or abdominal distension.One patient(patient 12)had a history of recurrent respiratory infections.Among the 10 patients,only one patient(patient 5)had two fistulas revealed by esophagography,three patients(patient 7,9,12)were found to have two fistulas by bronchoscopy,one patient(patient 11)was found to have two fistulas by combined bronchoscopy and gastroscopy,one patient(patient 3)had two fistulas discovered at autopsy,one patient(patient 4)had the second fistula discovered at autopsy,and three patients(patients 6,8,10)had the second fistula discovered during or after surgery.Four patients(patients 6-8,10)were cured by open surgery,and one patient(patient 12)was cured by thoracoscopic surgery.Conclusions DCTEFs is a rare disease with nonspecific clinical manifestations,prone to missed diagnosis.Careful search for the second fistula during examination is essential,and once diagnosed,surgical treatment should be performed promptly.
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