胃镜辅助下探条扩张在小儿食道狭窄中的应用

Application of Gastroscope Assistant Bougienage in Children's Esophageal Stricture

目的总结胃镜辅助下探条扩张技术在小儿食道狭窄性疾病中的应用,探讨影响探条扩张效果的因素。方法对2003年12月～2005年5月收治的11例食道狭窄患儿采用探条扩张法进行治疗,按扩张次数将患儿分为3组,分析各组间病因、食道狭窄长度和狭窄食管直径对扩张效果的影响。结果11例患儿共接受了36次扩张,平均每例扩张3.3次(1～10次),无1例发生并发症。1例患儿已进行手术治疗,1例等待手术,总有效率为81.8%(9/11)。A组4例,均为先天性食道闭锁术后吻合口狭窄患儿;B组4例,主要为先天性食道狭窄和胃食管返流术后仍合并返流患儿;C组3例,以食道化学性烧灼伤为主。A、B、C三组患儿食道扩张前狭窄段平均直径分别为4.8mm(3.0～6.0mm)、5.0mm(4.0～6.0mm)、4.3mm(4.0～5.0mm);平均狭窄段长度分别为1.8cm(1.5～2.0cm)、2.4cm(2.0～3.0cm)和6.8cm(4.5cm～10.0cm)。扩张有效率分别为100%(4/4)、100%(4/4)和33.3%(1/3)。三组间病因不同,C组患儿食道狭窄段平均直径虽小于其他两组,但不具有显著性差异;其食道狭窄段长度显著大于其他两组,P<0.05。C组患儿扩张有效率显著低于A、B组(P<0.05)。结论胃镜辅助下食道探条扩张方法安全、有效。食道术后吻合口狭窄患儿扩张有效率高;化学性烧灼伤患儿存在反复多次扩张和再手术问题。食道狭窄段长度比狭窄段直径更能影响扩张的效果。

Objective The purpose of this study was to introduce the application of gastroscope assistant bougienage in children＇s esophageal stricture and to assess factors influencing the effectiveness of this procedure. Methods From Dec 2003 to May 2005, 11 patients with a diagnosis of esophageal stricture at our hospital were enrolled and treated with gastroscope assistant bougienage. Patients were divided into three groups depending on the times of dilation： group A, n=1; group B, 1〈n〈5; group C, n ≥5. Pathogeny, stricture length and stricture diameter were analysed to assess the influencing of dilation effectiveness. Results The 11 patients received a total of 36 times of bougienage, average 3.3 （1-10）, no complications. Total effectiveness was 81.8%（9/11）, One had operation, one is waiting. 4 in group A, anastomosis stricture after surgery for esophageal atresia; 4 in group B, congenital esophageal stricture and complications from reflux esophagitis; 3 in group C, majority caustic ingestion injury. Stricture diameter of three groups was 4.8mm（3.0-6.0mm）, 5.0mm（4.0-6.0mm） and 4.3mm（4.0-5.0mm） respectively; Mean stricture length of three groups was 1.8cm （1.5-2.0cm）, 2.4cm（2.0-3.0cm） and 6.8cm （4.5-10.0cm）respectively, The effectiveness of three groups was 100%（4/4）, 100%（4/4） and 33.3%（1/9） respectively, There was different pathogeny in three groups. Group C had smaller stricture diameter and longer stricture length than these of groups A and B, The later factor had significant statistic difference （P〈0.05）, Group C had lower effectiveness than the others （P〈0.05）. Conclusion The application of gastroscope assistant bougienage in children＇s esophageal stricture treatment is safety and effectiveness. There is a higher effectiveness in anastomosis stricture group than in caustic injury group. Stricture length is a more important factor influencing the effectiveness than stricture diameter,