超声内镜检查在儿童上消化道狭窄诊断与治疗中的应用价值

Application value of endoscopic ultrasound in diagnosis and treatment of upper gastrointestinal stenosis in children

目的探讨超声内镜检查在儿童上消化道狭窄诊断与治疗中的应用价值。方法回顾性分析2015年5月至2020年5月山东大学附属儿童医院收治的上消化道狭窄患儿48例,包括食管狭窄27例(其中食管闭锁术后吻合口狭窄18例,化学腐蚀性食管狭窄3例,异物所致食管狭窄1例,病因不明食管狭窄5例),贲门失弛缓症4例,胃输出端狭窄12例,十二指肠狭窄5例。所有患儿均在麻醉状态下行超声内镜检查进行术前评估,根据上消化道狭窄部位、狭窄口大小及超声内镜下改变,选择不同的治疗方案。结果18例食管闭锁术后吻合口狭窄患儿超声内镜显示食管管壁层次分界不清,环狭窄口周围管壁厚度不均;3例腐蚀性食管损伤患儿超声内镜显示食管损伤程度不一;异物所致食管狭窄1例患儿超声内镜显示异物回声;病因不明食管狭窄5例患儿超声内镜示管壁层次分界不清。贲门失弛缓症4例患儿超声内镜显示贲门固有肌层厚度为0.9~4.0 mm。胃输出端狭窄12例患儿超声内镜显示狭窄部位层次不清、厚薄不均。十二指肠狭窄5例患儿中,4例为先天性发育异常,超声内镜显示狭窄部位局部组织呈均匀回声;1例为消化性溃疡所致十二指肠狭窄,超声内镜显示幽门黏膜隆起处管壁层次模糊。结论超声内镜检查可以明确儿童上消化道狭窄病变的起源及层次,有助于诊断和术前风险的评估,并为治疗方案的选择提供重要依据。

Objective To evaluate the application value of endoscopic ultrasound in the diagnosis and treatment of upper gastrointestinal stenosis in children.Methods A total of 48 children with upper gastrointestinal stenosis admitted to Children’s Hospital Affiliated to Shandong University from May 2015 to May 2020 were analyzed retrospectively.There were 27 cases of esophageal stricture(18 cases of anastomotic stricture after surgical correction of esophageal atresia,3 cases of chemically corrosive stricture,1 case of esophageal stricture caused by foreign body,5 cases of esophageal stricture of unknown etiology),4 cases of achalasia,12 cases of gastric output stricture,and 5 cases of duodenal stricture.All the children were evaluated by endoscopic ultrasonography before surgery under anesthesia,and different treatment plans were selected according to the stenosis site of upper gastrointestinal tract,stenosis opening size and endoscopic ultrasonography changes.Results Endoscopic ultrasonography showed that the boundary of esophageal wall layer was not clear,and the thickness of the wall around the annular stenosis was uneven in 18 children with anastomotic stricture after surgical correction of esophageal atresia.Endoscopic ultrasonography showed different degree of esophageal injury in 3 children with corrosive esophageal injury.Endoscopic ultrasonography showed echo of foreign body in 1 child with esophageal stenosis caused by foreign body.Endoscopic ultrasonography showed unclear stratification of esophageal wall in 5 children with unexplained esophageal stenosis.Endoscopic ultrasonography showed that the thickness of cardia proper muscle layer was 0.9-4.0 mm in 4 children with achalasia.Endoscopic ultrasonography showed that the level of stenosis was not clear and the thickness was uneven in 12 children with gastric output stenosis.Among the 5 cases of duodenal stenosis,4 cases of congenital dysplasia showed homogeneous echo in local tissues at the stenosis site by endoscopic ultrasonography,the other case was duodenal stricture caused by peptic ulcer,and endoscopic ultrasonography showed that the pyloric mucosa eminence was blurred.Conclusion Endoscopic ultrasound can accurately discover the origin and level of upper gastrointestinal stenosis in children,contribute to diagnosis and preoperative risk assessment,and provide an important basis for the selection of treatment plan.