THE DIAGNOSIS AND TREATMENT OF ATRESIA OF THE ESOPHAGUS AND TRACHEO-ESOPHAGEAL FISTULA

[摘要] DURING the past few years there have been an increasing number of reports on the successful operative correction of atresia of the esophagus and tracheo-esophageal fistula.In the past eight years at the Children's Hospital in Boston, 113 such cases have been operated upon and 57 of the patients have survived.There are certain facts about normal embryologic development which afford some explanation of these congenital malformations. In early fetal life, the esophagus and [SEE FIG. 1-a FIG. 1-b IN SOURCE PDF] trachea are one tube, which subsequently becomes divided into two structures by the lateral ingrowth of mesoderm. After this division, the lumen of the esophagus becomes obliterated by the proliferation and concrescence of its epithelial lining. Later, as this solid cord becomes vacuolated and coalescence of the vacuoles occurs, the lumen of the esophagus is re-established. It is probably in the period of separation of the single structure into esophagus and trachea that tracheo-esophageal fistulas develop. Esophageal atresia is probably related to incomplete coalescence of the vacuoles.The anatomic variations of the anomaly can be divided into five groups. In the simplest form of the anomaly, the upper portion of the esophagus ends in a blind pouch in the upper portion of the chest and the lower esophageal segment begins again as a blind [SEE FIG. 2-b FIG. 2-a IN SOURCE PDF] pouch somewhat above the diaphragm (Fig. 1-a). About 3% of the cases are of this type. In the commonest form of the anomaly a tracheo-esophageal fistula is associated with the atresia, and in 94% of the cases communicates with the lower esophageal segment.

[学科分类] 儿科学