Esophageal atresia
Introduction
Introduction Esophageal atresia, also known as esophageal atresia, is a natural esophageal atresia. It is not uncommon in the neonatal period. After the child is born, there is an increase in saliva, which constantly overflows from the mouth and frequently spits foam. Atresia of oesophagus and tracheoesophagealfistula are not uncommon in the neonatal period. After the birth of the child, saliva increases, and the foam overflows from the mouth. Atresia of oesophagus and tracheoesophagealfistula are not uncommon in the neonatal period. According to domestic statistics, the incidence rate is 1 in 2000 to 4500 newborns, which is similar to the foreign incidence rate (2500-3000). 1 of the newborns). It is the third place in the digestive tract developmental malformation, second only to anorectal malformation and congenital megacolon. The incidence of boys is slightly higher than that of girls. In the past, children with this disease died more than a few days after birth. In recent years, due to the development of pediatric surgery, the success rate of surgical treatment has increased.
Cause
Cause
The esophagus and trachea in the early stage of the embryo are all produced by the original foregut, and the two are in common. At 5 to 6 weeks, a mediastinum was grown from the mesoderm, and the esophageal trachea was separated, the ventral side was the trachea, and the dorsal side was the esophagus. After the esophagus passes through a consolidation stage, the epithelial cells in the tube multiply and proliferate, and the esophagus is occluded. Later, vacuoles appear in the tube, merge with each other, and the esophagus is re-passed into a hollow tube. If the embryo does not develop properly during the first 8 weeks, separation and cavitation may cause different types of malformations. Some people think that it is related to vascular abnormalities, and the supply of blood flow to the foregut is reduced, which can cause occlusion. Older women, low birth weight children are prone to occur, and 1/3 are premature infants.
Examine
an examination
Related inspection
Esophagography esophageal barium meal perspective
All newborns have foaming at the mouth and vomiting or coughing and bruising after each feeding. After the mother has a history of excessive amniotic fluid or other congenital malformations, congenital esophageal atresia should be considered. may. A soft abdomen indicates the presence of a fistula. In the upper section, there are symptoms such as coughing and difficulty in breathing after the fistula. Bloating occurs when there is a fistula in the lower part. Further clear diagnosis, simple method can be inserted into the No. 8 catheter from the nostril, when inserted into 8 ~ 12cm, often broken back due to obstruction, normal children can smoothly enter the stomach. However, it should be noted that sometimes the catheter is thinner and can be curled in the blind end of the esophagus, causing an illusion of stomach. Check the presence or absence of the fistula. The outer end of the catheter can be placed in the basin, and the catheter can be moved up and down in the esophagus. When the tip reaches the level of the fistula, blisters can be seen in the basin, and the child has more blisters when crying or coughing. The position of the fistula can also be determined based on the length of the insertion catheter. If there are conditions, you can take X-ray film, observe the obstruction of the catheter insertion, and understand the height of the blind end, generally in the thoracic vertebra 4 to 5 level. Type I and type II are not inflated in the stomach. Type III or IV, V-type air from the fistula into the stomach, visible gastrointestinal aeration. Intravenous injection of lipiodol 1 ~ 2ml for iodized oil angiography can check the presence or absence of fistula, generally do not routinely check, avoid the use of tincture, because of the risk of increased aspiration pneumonia. Some people used an esophagoscopy or a bronchoscope to directly observe, or dripped in the bronchoscope to observe the presence or absence of blue inflow in the esophagus. Try to strive for a clear diagnosis when there is no secondary pneumonia. Also check for pneumonia and other organ deformities (heart, digestion, urinary).
Diagnosis
Differential diagnosis
In the diagnosis, it is important to identify different types of esophageal atresia.
Congenital esophageal atresia can be divided into five types according to the position of the esophageal atresia and whether there is an esophageal fistula.
Type I 86.5%, Type II 0.8%, Type III 7.7%, Type IV 0.7%, Type V 4.2%.
1. The proximal part of the esophagus is a blind end, and the distal part opens into the posterior wall of the trachea to form an esophageal tracheal fistula. According to Holder statistics, this type is the most common, accounting for 86.5%.
2. The proximal part of the esophagus enters the posterior wall of the trachea, forming an esophageal tracheal fistula, and the distal end is a blind end. This type is rare, accounting for about 0.8%.
3. The proximal and distal esophagus are blind ends, no airway, no esophageal tracheal fistula. This type accounts for 7.7%.
4. The proximal and distal segments of the esophagus are respectively introduced into the posterior wall of the trachea to form two tracheal esophageal fistulas. This type is also rare, accounting for 0.7%.
5. The esophageal lumen is unobstructed and there is no occlusion, but the anterior wall of the esophagus communicates with the posterior wall of the trachea, forming an esophageal tracheal fistula, accounting for 4.2%.
In addition, the differential diagnosis of the disease should also include congenital heart disease with or without cyanosis; aortic arch malformation; all lesions that cause neonatal respiratory distress syndrome; laryngeal esophageal fissure; neurological dysphagia; gastroesophageal reflux Wait.
