胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄疗效的探讨

Efficacy of gastroscopy assisted balloon dilation for anastomotic stricture after esophageal atresia surgery

目的探讨胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄的效果,分析食管狭窄程度与扩张压力及治疗效果的关系。方法回顾性分析2021年1月至2023年3月山西省儿童医院收治的25例食管闭锁术后吻合口狭窄患儿,其中男11例,女14例,首次扩张年龄为(54.10±25.93)d,体重(4.35±0.86)kg。收集患儿首次球囊扩张时吻合口狭窄段的管直径和长度,以及使用外径φ8 mm球囊完全充盈情况下进行扩张时,所记录的扩张压力及总扩张次数。依据狭窄直径将患儿分成≤3 mm组与>3 mm组,其中≤3 mm组11例,>3 mm组14例;依据狭窄长度,将患儿分为≤5 mm组与>5 mm组,其中≤5 mm组18例,>5 mm组7例。参照Stooler法对治疗效果进行评估。采用t检验或χ^(2)检验进行组间差异比较。结果25例患儿共进行了104次球囊扩张术,扩张1次的3例,扩张2~5次15例,扩张5次以上7例。1例扩张时发生穿孔,保守治愈,其余吻合口狭窄均得到减轻或治愈,最终全部治愈。φ8 mm球囊完全充盈时容积0.6 ml,各组年龄、性别、体重等一般资料差异无统计学意义。狭窄直径≤3 mm组与>3 mm组扩张时的压力分别为(332±33)kPa、(252±21)kPa,扩张次数分别为(6.30±2.21)次、(2.47±1.06)次,组间比较差异均有统计学意义(均P=0.01)。狭窄长度≤5 mm组与>5 mm组扩张时的压力分别为(365±33)kPa、(268±38)kPa,扩张次数分别为(6.90±2.22)次、(3.06±1.66)次,组间比较差异均有统计学意义(均P=0.01)。结论胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄的效果良好,狭窄程度显著影响扩张压力和次数,狭窄程度越大,扩张压力越高、扩张次数越多。

Objective To explore the effect of gastroscopy assisted balloon dilation for anastomotic stricture after esophageal atresia(EA)surgery and to examine the relationship between esophageal stricture,dilation pressure and treatment efficacy.Methods From January 2021 to March 2023,retrospective analysis was conducted for 25 hospitalized children with anastomotic stricture after EA surgery.There were 11 boys and 14 girls with an age range of(54.10±25.93)days and a body weight of(4.35±0.86)kg.Diameter/length of anastomotic stricture segment during an initial balloon dilation,dilation pressure and total dilation frequency were recorded during a full dilation of 8 mm balloon.Based upon stricture diameter,they were assigned into two groups of≤3 mm and>3 mm;According to the length of stricture,they were assigned into two groups of≤5 mm and>5 mm.Treatment efficacy was evaluated by the Stooler method.Studert's t-test or Chisquare test was utilized for comparing the inter-group differences.Results There were a total of 104 balloon dilations.One case of perforation occurred during expansion and was conservatively cured.And all other anastomotic strictures were ultimately cured.The pressure during dilation was(332±33)and(252±21)kPa for groups≤3 mm and>3 mm.And the expansion frequency was(6.30±2.21)and(2.47±1.06)respectively.φ8 mm balloon had a fully filled volume of 0.6 ml.Statistically significant differences existed in pressure and expansion frequency between groups.The pressure during dilation in stricture length≤5 mm and>5 mm groups was(365±33)and(268±38)kPa.And the number of expansions was(6.90±2.22)and(3.06±1.66)respectively.Statistically significant differences existed in pressure and expansion frequency.Conclusions The efficacy of gastroscopy assisted balloon dilation is significant for anastomotic stricture after EA surgery.And degree of stricture greatly affects dilation pressure and frequency.The greater stricture,the higher dilation pressure and the greater frequency of dilation are needed.