Esophageal Atresia and Tracheoesophageal Fistula in Korea: A National Survery of Its Members by the Korean Association of Pediatric Surgeons

Abstract

The First national survey on esophageal atresia and tracheoesophageal fistula was conducted to access the current status of its incidence, clinical manifestation, preperative diagnosis and management, type of its anomaly, associated anomalies, and surgical results and course. The 43 members of the Korea associated of Pediatric Surseons received questionnaires and registration forms to be filled out on each patient who were born during the three years from January 1, 1992 through December 31, 1994. Questionnaires composed of six broad areas which include 1) preoperative diagnosis and management, 2) surgical technic, 3) long gap, 4) postoperative management, and 5) complications and courses. A total of 148 cases was returned by 28 members working at 23 insitution and 27 members returned questionnaires. We obtained the following results by analysis of the 148 cases of tracheoesophageal anomalies. The incidence of tracheoesophageal anomaly was about 1/10,000-11,000 in 1994, which is one third of that of ancrectal malformations in Korea and the distributin of the patients was almost proportionate to the size of each province. Both sexes are about equally affected. Majouity of the members make diagnosis of tracheoesophageal anomaly by taking a simple infantogram with a radiopaque tube in upper pouch and a little under half(48%) prefers to perform echocardiography as a part of preperative management to identify congenital heart disease and lateralize the aorta. Esophageal atresia with distal TEF(87.5%) was by far the most commom and threre were pure esopahgeal atresia(5.6%), H-type TEF(2.1%), and so on. About half(49%) of the patients had one or more associated anomalies in 15cases(10%), genitourinary anomalies in 10 cases(7%) and gastrointestinal anomalies in 7 cases(5%). Postoperatively, psrenteral nutrition and assisted ventilation were given in 66% and 52% of pareients respectively. Ninety three(74%) of 126 cases whounderwent sugical procedure, experienced one or more complications such as respiratory complication(65%), leak(22%), stricture(21%) and so on. The surviral rates related to the Waterston risk categories were 90.2% in grpup A, 71.4-95% in B1, B2 and C1 groups, and 28% in group C2 and the overall survuval rate was 71.4%. Thirty six(28.6%) of 126 cases died of pneumonia/sepsis(12 cases), respiratoty failure(12 cases), and congenital heart disease(4 cases). With short term follow-up, 69% of patients have been excellent whereas remainders of the cases have suffered from some sort of morvidity related to gastroesophageal reflux, recurrent respiratory infection, and esophageal stricure.

국내에서 처음으로 기관식도기형에 관하여 대한 소아외과 학회 회원을 대상으로 조사하였다. 본 연구는 두 부분으로 구성되어 있었는데 하나는 최근 3년간 출생한 기관식도기형의 등록된 자료를 분석하여 국내의 기관식도기형의 현황 즉 발병율 처치 및 치료 결과등에 관한 총체적인 경향을 외국과 비교 분석하여 우리 자료와 구미 보고와의 차별성 및 유사성을 분석하고저 했으며, 다른 하나는 질문서(questionnaires)분석을 토대로 11차 대한소아외과 학회 학술대회에서 토의된 내용을 기초로 회원들의 식도기형의 진단 치료, 술후 관리, 합병증 등에 대한 경험과 의견을 종합하여 고안을 작성하였다.