同: TEF
同: TEF

WordNet

an abnormal passage leading from a suppurating cavity to the body surface (同)sinus

PrepTutorEJDIC

瘻(ろう)菅(長い菅状になった潰瘍)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/10/03 03:58:21」(JST)

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A tracheoesophageal fistula (TEF, or TOF; see spelling differences) is an abnormal connection (fistula) between the esophagus and the trachea. TEF is a common congenital abnormality, but when occurring late in life is usually the sequela of surgical procedures such as a laryngectomy.

Causes[edit]

Congenital TEF can arise due to failed fusion of the tracheoesophageal ridges during the third week of embryological development.^[1]

A fistula, from the Latin meaning ‘a pipe,’ is an abnormal connection running either between two tubes or between a tube and a surface. In tracheo-esophageal fistula it runs between the trachea and the esophagus. This connection may or may not have a central cavity; if it does, then food within the esophagus may pass into the trachea (and on to the lungs) or alternatively, air in the trachea may cross into the esophagus.

TEF can also occur due to pressure necrosis by a tracheostomy tube in apposition to a nasogastric tube (NGT).^[2]

Associations[edit]

Neonates with TEF or esophageal atresia are unable to feed properly. Once diagnosed, prompt surgery is required to allow the food intake. Few children with TEF have problems after surgery; however, some develop dysphagia and thoracic problems. Some children with TEF are also born with other abnormalities, most commonly those described in VACTERL association - a group of anomalies which often occur together, including heart, kidney and limb deformities. 6% of babies with TEF also have a laryngeal cleft.^[3]

Classification[edit]

Fistulae between the trachea and esophagus in the newborn can be of diverse morphology and anatomical location;^[4]^[5] however, various pediatric surgical publications have attempted a classification system based on the below specified types.

Not all types include both esophageal agenesis and tracheoesophageal fistula, but the most common types do.

Gross	Vogt^[6]	Description	EA?	TEF?
-	Type 1	Esophageal agenesis. Very rare, and not included in the classification by Gross.^[7]	Yes	No
Type A	Type 2	Proximal and distal esophageal bud—a normal esophagus with a missing mid-segment.	Yes	No
Type B	Type 3A	Proximal esophageal termination on the lower trachea with distal esophageal bud.	Yes	Yes
Type C	Type 3B	Proximal esophageal atresia (esophagus continuous with the mouth ending in a blind loop superior to the sternal angle) with a distal esophagus arising from the lower trachea or carina. (Most common, up to 90% of cases.)	Yes	Yes
Type D	Type 3C	Proximal esophageal termination on the lower trachea or carina with distal esophagus arising from the carina.	Yes	Yes
Type E (or H-Type)	-	A variant of type D: if the two segments of esophagus communicate, this is sometimes termed an H-type fistula due to its resemblance to the letter H. TEF without EA.	No	Yes

The letter codes are usually associated with the system used by Gross,^[8] while number codes are usually associated with Vogt.^[9]

An additional type, "blind upper segment only" has been described,^[10] but this type is not usually included in most classifications.

(For the purposes of this discussion, proximal esophagus indicates normal esophageal tissue arising normally from the pharynx, and distal esophagus indicates normal esophageal tissue emptying into the proximal stomach.)

Clinical presentation[edit]

Tracheoesophageal fistula is suggested in a newborn by copious salivation associated with choking, coughing, vomiting, and cyanosis coincident with the onset of feeding. Esophageal atresia and the subsequent inability to swallow typically cause polyhydramnios in utero. Rarely it may present in an adult.^[11]

Treatment[edit]

It is surgically corrected, with resection of any fistula and anastomosis of any discontinuous segments. Surgical repair is associated with complications, including

Stricture, due to gastric acid erosion of the shortened esophagus.
Leak of contents at the point of anastomosis.
Recurrence of fistula.

References[edit]

^ Clark DC (February 1999). "Esophageal atresia and tracheoesophageal fistula". American Family Physician 59 (4): 910–6, 919–20. PMID 10068713.
^ Dr. Lorne H. Blackbourne, Advanced Surgical Recall, 3rd Ed., pg. 206.
^ Bluestone, Charles D. (2003). Pediatric otolaryngology, Volume 2. Elsevier Health Sciences. p. 1468. ISBN 0-7216-9197-8.
^ Spitz L (2007). "Oesophageal atresia". Orphanet journal of rare diseases 2 (1): 24. doi:10.1186/1750-1172-2-24. PMC 1884133. PMID 17498283.
^ Kovesi T, Rubin S (2004). "Long-term complications of congenital esophageal atresia and/or tracheoesophageal fistula". Chest 126 (3): 915–25. doi:10.1378/chest.126.3.915. PMID 15364774.
^ "Long-term Complications of Congenital Esophageal Atresia and/or Tracheoesophageal Fistula -- Kovesi and Rubin 126 (3): 915 Figure 1 -- Chest". Retrieved 2008-10-11.
^ P. Puri ; M. E. Höllwarth (ed.) (2005). Pediatric Surgery (Springer Surgery Atlas Series). Berlin: Springer. p. 30. ISBN 3-540-40738-3.
^ Gross, RE. The surgery of infancy and childhood. Philadelphia, WB Saunders; 1953.
^ Vogt EC. Congenital esophageal atresia. Am J of Roentgenol. 1929;22:463–465.
^ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. p. 800. ISBN 0-7216-0187-1.
^ D. Newberry, V. Sharma, D. Reiff, and F. De Lorenzo. A "little cough" for 40 years. Lancet, 354(9185):1174, Oct 1999.PMID:10513712

External links[edit]

TOFS: The Tracheo Esophageal Support Group
Swiss embryology (from UL, UB, and UF) rrespiratory/patholrespi01

UpToDate Contents

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1. 胸腔内気道の先天異常および気管食道瘻 congenital anomalies of the intrathoracic airways and tracheoesophageal fistula
2. 気管内チューブのマネージメントおよび合併症 endotracheal tube management and complications
3. 限局進行性の切除不能食道癌のマネージメント management of locally advanced unresectable esophageal cancer
4. 分子標的薬である血管新生阻害剤の毒性：心血管系以外への影響 toxicity of molecularly targeted antiangiogenic agents non cardiovascular effects
5. 幼児および小児における嚥下障害による誤嚥 aspiration due to swallowing dysfunction in infants and children

English Journal

Clinical outcomes of tracheoesophageal diversion and laryngotracheal separation for aspiration in patients with severe motor and intellectual disability.

Takano K1, Kurose M1, Mitsuzawa H2, Nagaya T1,2, Himi T1.
Acta oto-laryngologica.Acta Otolaryngol.2015 Dec;135(12):1304-10. doi: 10.3109/00016489.2015.1067905. Epub 2015 Jul 25.
CONCLUSIONS: Tracheoesophageal diversion (TED) and laryngotracheal separation (LTS) can prevent aspiration pneumonia and improve the morbidity of patients with severe motor and intellectual disability (SMID). By improving hospitalization rates and care needs, the quality-of-life can be improved for
PMID 26211394

Large tracheobronchial fistula due to esophageal stent migration: Let it be!

Fiorelli A1, Esposito G2, Pedicelli I3, Reginelli A4, Esposito P5, Santini M6.
Asian cardiovascular & thoracic annals.Asian Cardiovasc Thorac Ann.2015 Nov;23(9):1106-9. doi: 10.1177/0218492315587816. Epub 2015 Jun 4.
We report tracheal-bronchial migration of a covered esophageal self-expanding metal stent used to relieve dysphagia in a patient with advanced esophageal cancer. The stent eroded the trachea and completely occluded the main left bronchus. Surgery was contraindicated due to her poor clinical conditio
PMID 26045491

The effects of indwelling voice prosthesis on the quality of life, depressive symptoms, and self-esteem in patients with total laryngectomy.

Polat B1, Orhan KS2, Kesimli MC3, Gorgulu Y4, Ulusan M2, Deger K2.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery.Eur Arch Otorhinolaryngol.2015 Nov;272(11):3431-7. doi: 10.1007/s00405-014-3335-5. Epub 2014 Oct 19.
This study aims to evaluate the effects of voice rehabilitation with indwelling voice prosthesis on quality of life, depression, anxiety, self-esteem, and sexual functions in laryngectomy patients. Provox-1™ was applied to 30 patients who underwent total laryngectomy by opening a tracheoesophageal
PMID 25326899

Japanese Journal

6. 小児内視鏡手術の展開(<特集>わが国の小児外科五十年のあゆみ)

岩中督
日本外科学会雑誌 115(6), 329-333, 2014-11-01
NAID 110009872625

症例報告特殊型先天性食道閉鎖症Kluth分類V₆型の治療経験

中原康雄,岩村喜信,新居章 [他]
日本小児外科学会雑誌 50(6), 1057-1060, 2014-10
NAID 40020240522

臨床トピックス小児外科食道閉鎖症に対する胸腔鏡下手術 : 定型的な手術から新たな手術法の確立へ

内田広夫,小野靖之,村瀬成彦 [他]
現代医学 62(1), 93-99, 2014-06
NAID 40020182667

Related Pictures

★リンクテーブル★

リンク元	「気管食道瘻」「VACTERL連合」「TEF」

「気管食道瘻」

Tracheoesophageal fistula
	Classification and external resources
ICD-10	J95.0, Q39.1-Q39.2
ICD-9	530.84, 750.3
DiseasesDB	30034
eMedicine	med/3416
MeSH	D014138

　　[★]

英: tracheoesophageal fistula T-E fistula
同: 先天性気管食道瘻 congenital tracheoesophageal fistula、食道気管瘻 esophagotracheal fistula、食道気管支瘻？？

[show details]

食道気管瘻 : 約 23,400 件
気管食道瘻 : 約 68,200 件

gross分類

A：食道の上端と下端がつながっていない

B：食道下端が気管に瘻孔を形成

C：食道上端が気管に瘻孔を形成

D：食道上端と食道下端が違う場所で気管に瘻孔を形成

E：食道上端と食道下端が同じ場所で気管に瘻孔を形成