What is the best way to treat tracheoesophageal fistula?

The occurrence of esophageal tracheal fistula causes great impact and harm. In order to more effectively reduce its impact and harm, it is necessary to pay attention to the correct treatment method and perform fistula repair, resection and esophageal reconstruction according to the condition.

1. The respiratory organs from trachea to alveoli first develop from the groove-like depression (lung gro-ove) on the ventral wall of the foregut (which later developed into the esophagus). At some later stage, the opening between the esophagus and trachea is completely closed by the esophageal tracheal septum extending from the back, leaving only the laryngeal part. If this closure is incomplete, an opening between the trachea and esophagus will be left outside the larynx, which is called tracheoesophageal fistula.

2. During development, the esophagus and respiratory tract both originate from the foregut of the embryonic gastrula. The primitive esophagus is located behind the respiratory organs. The archenteron is divided into three parts: foregut, midgut and hindgut. Early on, both the rostral and caudal sides of the archenteron are atretic. At the end of the third week of embryogenesis, the pharyngeal membrane on the head side of the archenteron ruptures, allowing the foregut to communicate with the oral cavity. As the heart moves downward, the length of the esophagus increases rapidly. On the 21st to 26th day of embryogenesis, laryngeal tracheal grooves appear on both sides of the foregut, and then the epithelium grows to form the esophageal tracheal septum, separating the esophagus from the trachea. If the esophagus and trachea are not completely separated and the lumens of the two are connected, an esophageal-tracheal fistula is formed. Esophageal atresia occurs when the esophageal tracheal septum is displaced posteriorly or the foregut epithelium grows excessively into the esophageal lumen. In addition, in the early stages of esophageal development, some foregut cells separate from the esophagus and continue to grow, which can lead to esophageal duplication, which is mostly manifested as cysts close to the esophageal wall, and some cysts communicate with the esophageal cavity.

3. Early surgical treatment is recommended, and fistula repair, resection and/or esophageal reconstruction, and short-term gastrostomy should be performed according to the condition. To facilitate feeding and control aspiration pneumonia. The prognosis is good, but follow-up observation should be paid attention to after surgery. Some patients may still suffer from recurrent respiratory tract infections due to combined reasons such as reverse peristalsis after incomplete closure of the lower esophageal sphincter. It is advisable to sleep and feed with the head elevated.