小儿食管裂孔疝合并食管狭窄的综合治疗

Comprehensive treatment for hiatus hernia associated with reflux esophageal stenosis in children:a report of 2 cases

目的总结小儿食管裂孔疝合并食管狭窄的治疗结果，探讨其综合治疗对策。方法对2005年1月至2014年12月作者收治的2例食管裂孔疝合并食管狭窄患儿进行回顾性总结，采用腹腔镜下食管裂孔疝修补术＋Nissen—Rossettil胃底折叠抗反流术，术后在DSA透视下进行食管球囊导管扩张治疗，并应用抑酸药物减少食管反流。结果2例均为男性，初诊年龄分别为6个月和17个月，术前上消化道造影检查提示食管裂孔疝合并食管狭窄，术中置食管支撑管均失败，仅能通过6F胃管。术后给予口服药物控制反流，保护食管黏膜，并分别行食管球囊导管扩张治疗8次和2次，从6#球囊导管扩张至10#～12#球囊导管，扩张后均能进食半流质，吞咽功能良好，无反流症状。结论小儿食管裂孔疝合并食管狭窄通过腹腔镜食管裂孔疝修补术＋胃底折叠抗反流术、食管球囊导管扩张和药物治疗可达到满意的疗效。

Objective To evaluate the clinical outcomes of hiatus hernia associated with reflux esopha- geal stenosis in children and cxamlne the comprehensive treatment measures. Methods This retrospective study was conducted for two patients of hiatus hernia associated with reflux esophageal stenosis between January 2005 and December 2014. Esophageal balloon catheter dilatations were performed and acid suppressants pre- scribed for reducing reflux after laparoseopie Nissen-Rossettil fundoplieation anti-reflux surgery. Results Both patients were boys with a diagnostic age of 6 and 17 months respectively. Upper gastrointestinal radiography re- vealed preoperative esophageal hiatal hernia complicated with esophageal stenosis. A bougie could not be in- serted intraoperatlvely through esophagus. Only a 6F nasogastric tube was implanted. Acid suppressants were used for reducing reflux and protecting esophageal mueosa. Eight and 2 dilatations of esophageal balloon cathe- ter were performed respectively. It began with 6# balloon catheter＇up to 10#-12#. Swallowing function was excel- lent after dilating and there was no symptom of reflux. Conclusions Children of hiatus hernia associated with reflux esophageal stenosis may be comprehensively treated by laparoscopie Nissen-Rossettil fundoplication anti- reflux surgery, esophageal balloon catheter dilatation and acid suppressants.