A case of esophageal esophageal fistula with the treatment of esophageal lock-in with fibrosis-guided tracheostomy-guided tracheostomy."

!---- child, female, 1d after birth, natural vaginal delivery, birth weight 2790g, Apgar score 9Due to "post-birth vomiting, difficulty in putting into the gastric tube" hospital admission, chest CT diagnosis esophageal attination with trachea esophageal fistula (III.b possible), preoperative cardiac ultrasound examination prompted room interval defects (0.7 cm), normal heart function, the proposed trachea intubation general anaesthetic undergoing trachea esophageal fistula ligation and esophagus end matchingAfter entering the operating room, the child connected to a multi-function monitor to monitor ECG, SpO2, HR, BP and body temperature, the mask oxygen-absorbing child SpO2 can be maintained at about 95%Intravenous injection of atropine 0.01 mg/kg, using 4% heptafluoroetheride inhalation induction, FiO2 100%, oxygen flow 4 to 5L/min, according to the respiratory range of the child to adjust the concentration of inhalation heptafluoroetheration, using visual laryngoscope exposure sound door According to the size of the sound door, choose ID3.5mm ordinary trachea duct intubation, the front end of the catheter through the sound door to stop entering, the fiber bronchoscopy (outer diameter 2.8mm) inserted into the trachea duct so that the front of the tube is located in the front of the tube, guide the catheter into the trachea depthAfter the catheter over-the-loud door, the assistant gives the shun aquuke ammonium 0.1mg/kg, propofol 1mg/kg, Midazolam 0.05mg/kg, fentanyl 1?g/kgA fistula can be seen in the back wall of the trachea, approximately 0.4 cm above the upper part of the trachea, with transparent gastric fluid spillingGuide the tip of the catheter across the fistula between the fistula and the trachea protrusion, the rotating catheter allows the catheter Murphy hole to be on the opposite side of the fistula and maximizes the coverage of the fistula (Figure 1), marking the depth of the catheter insertionPull out the fiber bronchoscopy, connect the ventilator-controlled breathing, pressure ventilation mode, PEEP4 cmH2O, RR30 times/ minute, maintain PETCO2 at 30 to 40mmHg, 2% heptafluorite inhalation maintenanceThe operation uses the left side lying position, and the side lying fiber bronchoscopy to check the catheter positionIn the course of surgery, fentanyl is added to 0.5 to 1 ?g/kg at a time as neededFistula ligation completed, line fiber bronchoscopy examination see fistula ligation exactly, airways no narrow, no blood clots blocked the airways, gastric fluid reflux and so onThere was no significant dilation of the stomach during or after surgery in the childSurgical trachea catheter to the NICUTo discuss congenital esophageal locklock and tracheoesophageal fistula is a serious congenital malformation, usually using gross five classification, of which type III.b is the most common, the incidence ratio is 86%, because the performance of the upper end of the esophagus locklock lower end and trachea, to prevent anesthesia induction and surgery in the process of gastric over-expansion has become one of the key problems of anesthesiomic managementDue to the advantages of low irritation to respiratory tract, good controllability and hemodynamic stability, heptafluoroetherative ether has been used for neonatal inhalation induction, iii.b esophageal inlocking with trachea fistula in children with inhalation induction can reduce the occurrence of gastric over-expansionWe use a concentration of 4% heptafluoroetheration began inhalation induction, and according to the respiratory range of the child to adjust the concentration of inhalation heptaflueeeeeeee ether, so that the child retains self-breathing, after intubation of the child's upper abdomen did not see significant expansionIII.b type esophageal inlocking with trachea fistula children tracheal catheter placement location is particularly critical, the ideal position should be the catheter tip across the fistula and close to the protrusion, there are authors reported that the catheter first inserted into one side of the total bronchial tube, side listening to the lung breathing sound, side pull out the catheter, waiting for the lung breathing sound on both sides symmetrically pulled out 1 to 1.5 cm, and observe whether the control of breathing gastric gasation method to determine the location of the catheter, although there is still a good effect Fiber bronchoscopy has been reported for trachea conduit ational positioning due to its visual and easy-to-operate characteristics Deanovic et al believe that esophageal incarcedon associated with tracheal esophageal fistula in children using fibrous bronchoscopy-assisted intubation can detect fistula in a timely manner and prevent tracheal catheters from straying into the fistula, while checking the trachea for other deformities, etc We perform tracheal catheterization under the guidance of a fiber bronchoscopy mirror and, visually, use a rotating trachea duct to keep the catheter Murphy hole away from the fistula, preventing the gas from entering the fistula from the catheter Murphy hole After changes in position and fistula ligation, the catheter position and surgical effect were again examined with fibrous bronchoscopy, and the child did not show significant dilation of the stomach during and after surgery Some scholars also recommend the use of catheter blocking fistula to reduce gastric dilation, Papoff and other reports in the fibrous bronchoscopy of the umbilical vascular catheter into the fistula to reduce the gas into the stomach, the appearance of gastric gas through the catheter to suck the gas out, to a certain extent, can alleviate gastric dilation