经消化道腔内磁压榨吻合术治疗短段未完全闭锁小儿腐蚀性食管狭窄

Feasibility and therapeutic outcome of endoluminal magnetic compression anastomosis for caustic esophageal stricture

目的探讨采用磁压榨吻合术治疗腐蚀性食管狭窄的可行性并总结治疗经验。方法患儿误食少量强碱后出现吞咽不畅1年余，外院诊断为腐蚀性食管狭窄。我院行食管扩张术6次，效果欠佳；改行磁压榨食管吻合术，先行胃造瘘术改善营养并建立操作通道，待胃造瘘成熟后择期在全麻下分别经口、胃造瘘口放置磁环，完成吻合后经胃造瘘口取出对合压榨后的磁环，术后定期随访复诊。结果手术顺利，无术中并发症。手术时间60 min，术后3 d内吐出较多唾液伴阵发性胸部疼痛，对症处理缓解；术后第1天排气，术后第2天排便；术后每日摄胸部X线片连续3 d，未发现磁环移位、扭转、成角、滑脱，且磁环间距逐渐缩小至术后第3天不足1 mm；术后10 d、2周胃镜检查，镜下观察磁环对合良好，活动度大；术后第18天顺利取出磁环，胃镜检查吻合处通畅、黏膜光滑无瘢痕形成，无明显渗、出血及狭窄；磁环完整无破损，磁环间可见直径约1.0 cm圆环状脱落组织块，病理结果为坏死组织。术后随访6个月，术后间隔1个月行食管预防性扩张术2次，胃镜复查未见异常，患儿进食正常。结论经消化道腔内磁压榨吻合术治疗小儿腐蚀性食管狭窄具有微创、有效等特点，有望成为治疗短段未完全闭锁小儿腐蚀性食管狭窄的新方法。

ObjectiveTo explore the feasibility and therapeutic outcome of endoluminal magnetic compression anastomosis for caustic esophageal stricture after esophageal alkline agent burns.MethodsAt over half a month after ingesting a small amount of strong alkali, esophageal stenotic symptoms appeared in a 1-year-old child diagnosed as corrosive esophageal stricture. Six dilatations of esophagus were performed without obvious effect. And this patient was advised to undergo an endo-luminal magnetic compression anastomosis. After gastrostomy, the magnetic rings were placed through mouth and stoma of gastrostomy under general anesthesia, respectively. The compressed rings were removed from stoma of gastrostomy after completions of anastomosis. Chest radiography was used for assessing the location and angle of magnetic rings. The postoperative follow-up interval was 1 month.ResultsDuring an operative duration of 60min, there was no onset of intraoperative complications. Within the first three days, salivation with paroxysmal chest pain appeared and gradually alleviated. Daily chest radiography showed no sign of ectopic location, torsion, or angulation of magnetic rings. Distance between magnetic rings gradually decreased and was less than 1mm at Day 3. And endoscopy at Days 10 and 14 revealed that magnetic rings in esophagus were in state of magnetic attraction and moved slightly. The magnetic rings were removed successfully at Day 18 and endoscopy showed a smooth esophageal mucosa without scarring and no obvious infiltration/hemorrhage/rupture at the site of anastomosis. Conventional pathology of compressed tissue showed necrotic. At the successive six-month follow-ups, two dilatations were performed. The boy had no stenotic esophageal symptoms during ingestion. Re-examining endoscopy showed normal.ConclusionsEndoluminal magnetic compression anastomosis is mini-invasive and efficacious for short and incomplete-atresia caustic esophageal stricture.