先天性食管狭窄15例诊疗体会

Management of congenital esophageal stenosis., retrospective study of 15 cases

目的 总结先天性食管狭窄诊断和治疗体会，提出最佳的诊断、治疗方法。方法 回顾我院1990至2009收治的15例先天性食管狭窄临床资料，对临床表现（症状、体征、发病年龄等），诊断方法（UGI、胃镜等）进行分析。将患儿分为手术组与非手术组，比较两组治疗过程和预后情况（饮食状况、并发症等）。结果 15例先天性食管狭窄患儿，男9例，女6例。发病年龄（10±5．5）个月（O～3岁9个月）。主要临床表现为反复进食后呕吐。GI检查发现狭窄段位于食管下段者9例，位于中下段者6例。7例仅行胃镜辅助下食管扩张术，手术治疗8例，其中6例行狭窄段食管切除＋端端吻合术，1例行狭窄段肌层切开＋胃底折叠术，1例行狭窄段全层切开、纵切横缝＋胃底折叠术。术后病理诊断2例为气管软骨异位型，1例为狭窄局部炎性假瘤形成，5例为肌层增厚型。术后4例出现吻合口狭窄，2例出现胃食管反流，1例伴发术侧膈膨升。结论 上消化道钡剂造影（UGI）是诊断首选方法，电子胃镜可作为诊断及辅助治疗的手段。治疗方法建议首选食管扩张术，对扩张2～3次以上无效者进行手术探查。下段狭窄者应行胃底折叠术避免术后并发胃食管反流。

Objective The aim of this study was to find an optimal procedure of diagnosis and treatment for congenital esophageal stenosis （CES）. Methods From 1990 to 2009, 15 CES patients were treated in our hospital. Demographical, clinical, pathological and radiological data were collected retrospectively. Patients were further divided into surgery group and non-surgery group. Outcomes and complications were studied to identify the indication and timing for operation. Results The age of presentationof of these 15 patients （9 boys and 6 girls） were 10±5.5 months （1 day - 41months ）. Vomiting was the most significant and common symptomign. UGI were performed in all the 15 patients. 9 patients had stenosis in lower esophagus and 6 in mid-lower esophagus. In surgery group, 6 patients underwent surgical resection; the remaining 2 patients underwent Heller myotomy esophagomyotomy and stricturoplasty, respectively. Tracheobronchial remnants were found in 2 patients and submucosal thickening were found in 5 patients. Inflammatory pseudotumor was found in the rest 1 patient. The frequency of esophageal anastomotie stricture, gastroesophageal reflux and diaphragmatic erentration were 44. 4%（4/9）, 22. 2%（2/9） and 11.1%（1/9）, repectively. Conclusions UGI is the first choice for the diagnosis of CES, while electronic gastroscope can play an alternative role. Esophageal dilatation could be the first therapy for CES, and operation is indicated when outcome dilatation fails.