探条扩张或扩张联合支架置入术治疗小儿化学烧伤性食管狭窄的特征分析及效果评价

Characteristic analysis and efficacy evaluation of bougie dilation and bougie dilation combined with stent implantation for pediatric caustic esophageal stenosis

探讨内镜下探条扩张联合支架置入治疗小儿化学性烧伤合并食管狭窄的效果及安全性。回顾性分析2009年10月-2019年12月在解放军总医院第七医学中心消化内科就诊的50例小儿化学性烧伤食管狭窄患儿的临床特点及诊疗经过。50例患儿中94.0%(47/50)在入我院前接受过对应保守治疗及相应的处理,72.0%(36/50)误服强碱,22.0%(11/50)误服强酸,92.0%(46/50)吞食腐蚀性物质的患儿年龄<7岁,狭窄部位以食管上段多见(64.0%,32/50)。单纯探条扩张27例(54.0%),探条扩张联合支架治疗16例(32.0%)。50例患儿共扩张1260次,单纯扩张次数和联合支架扩张次数分别为(37.8±26.2)次、(20.9±12.6)次,差异有统计学意义(t=2.453,P=0.021)。接受外科手术2例,扩张联合手术和支架5例。治疗前后食管最狭窄处直径明显增宽[(1.1±0.2)cm比(0.2±0.1)cm,t=23.004,P<0.001],吞咽困难Stooler级别明显改善[(1.2±0.7)级比(3.5±0.5)级,t=19.925,P<0.001]。仅1例并发穿孔,经支架封堵保守治疗愈合,总有效率100.0%(50/50),满意率98.0%(49/50)。可见,内镜下探条扩张或扩张联合支架置入术治疗小儿化学性烧伤合并食管狭窄安全、有效,且联合支架治疗可减少扩张次数。

To investigate the efficacy and safety of endoscopic bougie dilation and stent implantation for pediatric caustic esophageal stenosis.Clinical characteristics,diagnosis and treatment of children with pediatric caustic esophageal stenosis from October 2009 to December 2019 at Department of Gastroenterology,the Seventh Medical Center of PLA General Hospital were retrospectively analyzed.A total of 50 caustic esophageal stenosis cases were enrolled,among whom,94.0%(47/50)received conservative treatment before sending to our hospital.Thirty-six(72.0%)of them accidently ingested caustic substance of alkali and 22.0%(11/50)of them accidently ingested caustic substance of acid.Forty-six children(92.0%)who ingested caustic agents were younger than 7 years old.The stenosis was more common in the upper esophagus,accounting for 64.0%(32/50).Twenty-seven cases(54.0%)underwent simple bougie dilation and 16 cases(32.0%)underwent bougie dilation combined with stent treatment.All 50 children underwent a total of 1260 expansions.The numbers of simple dilations and dilations combined with stent implantation were 37.8±26.2,20.9±12.6 respectively with significant difference(t=2.453,P=0.021).Among them,2 cases(4.0%)underwent surgery,5 cases(10.0%)underwent surgery combined with dilatation and stent implantation.The stenosis diameter widened significantly after treatment(1.1±0.2 cm VS 0.2±0.1 cm,t=23.004,P<0.001),and the Stooler grade of dysphagia improved significantly(grade 3.5±0.5 VS 1.2±0.7,t=19.925,P<0.001).Perforation occurred in only 1 patient,who was cured by conservative treatment with stent implantation.The total effective rate was 100.0%(50/50)and the satisfaction rate was 98.0%(49/50).Endoscopic bougie dilation and bougie dilation combined with stent implantation is safe and effective for pediatric caustic esophageal stenosis.Combination with stent implantation can reduce the number of dilation times.