小儿食道化学性碱烧伤狭窄的内镜下气囊扩张治疗分析

Analysis of endoscopic balloon dilation in children with esophageal stenosis caused by chemical alkali burns

目的探讨新疆地区小儿食道化学性烧伤狭窄的特点和内窥镜下气囊扩张治疗的安全性及临床价值。方法收集2009年1月至2017年10月,新疆维吾尔自治区人民医院20例食道化学碱烧伤狭窄的患儿术前通过消化道造影及胃镜检查诊断的临床资料,本组患者均采用胃镜下气囊扩张食道术。结果本组患者均胃镜下气囊扩张手术成功,食道穿孔0例,死亡0例,17例(85%)扩张术后再次出现进食困难及呕吐等食道狭窄症状,扩张治疗2～12次,平均3.7次/例,3例(15%)第1次扩张术后治愈。结论化学腐蚀剂灼伤粘膜及肌层,碱性液可渗透食道全层,肌层受损,出现瘢痕狭窄,严重者出现完全梗阻。本组食道狭窄的患儿均选用胃镜下气囊扩张术,直视下进行操作是安全,无辐射性,治疗有效满意。

Objective To investigate the characteristics of children's esophageal stricture caused by chemical burns in Xinjiang area,as well as to discuss the safety and clinical value of endoscopic balloon dilation therapy.Methods 20 children with esophageal stricture following alkali burns were firstly diagnosed through digestive tract radiography and gastroscopy,then they both received endoscopic balloon dilation.Results The endoscopic balloon dilation therapy was successful in all 20 cases,no esophageal perforation and death were happened,the symptoms of esophageal stenosis such as dysphasia and vomiting occurred in 17 cases(85%).Conclusions Chemical etchant could burn the mucous membrane and muscular layer of esophagus,the alkaline solution is able to permeate the whole membrane of the esophagus.The damage of muscular layer would lead to the cicatricial stenosis,even cause the complete obstruction of esophagus.This group of children with esophageal stenosis were treated with balloon dilation through gastroscope.This operation is safe and nonradiative,the treatment result is effective and satisfactory.