頚部アプローチによる先天性食道閉鎖症 (Gross D型) の根治術

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The repair of esophageal atresia is usually performed by thoracic approach. To date, only three cases of cervical approach have been reported. This is the fourth report of esophageal atresia repaired by cervical approach. A female infant, 2966g in birth weight, with frothy salivary secretion was transported to our hospital 19 hours after birth. Esophagography confirmed that she had esophageal atresia with proximal and distal tracheoesophageal fistulas. The distal fistula was seen at the lower level of the clavicle in X-ray, and was observed at the suprasternal notch by bronchoscopy. The esophageal atresia was operated on the third day after birth. The skin was incised transversely at the right supraclavicular region, and the sternocleidomastoid muscle was retracted to the right side. The distance between the proximal and the distal fistulae was approximately 1 cm. After the division of the fistulae, primary esophageal anastomosis was performed in one layer. The suture sites of tracheal fistulae were covered by a flap of the sternohyoid fascia which was inserted between the trachea and esophagus. After surgery, transient recurrent laryngeal nerve palsy and wound infection developed, but both resolved within 4 weeks. The girl is now growing well without any problems. This case emphasizes that a pediatric surgeon should recognize the presence of cervical esophageal atresia in which distal tracheoesophageal fistula is located above the clavicle. Thoracic extrapleural approach for repair is incorrect in this case. The most reliable means of finding the location of the distal tracheoesophageal fistula is telescopic brochoscopy.
1990-02-20

頚部アプローチによる先天性食道閉鎖症 (Gross D型) の根治術

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