儿童食管狭窄外科治疗策略

Surgical options for esophageal stenosis in children

目的探讨儿童食管狭窄外科递进式个体化治疗方法的临床疗效。方法分析2017年1月至2022年12月在南京医科大学附属儿童医院心胸外科治疗并定期随访的106例食管狭窄患儿的病例资料,其中男59例,女47例;年龄为(3.00±0.75)岁,体重为(9.00±1.25)kg。食管闭锁术后吻合口狭窄58例,腐蚀性食管狭窄47例,先天性食管狭窄1例。应用胃镜直视下球囊扩张、食管黏膜下注射药物、食管支架置入、外科手术的序贯治疗方法治疗儿童食管狭窄。术后通过食管造影、胃镜检查观察食管狭窄程度,结合患儿吞咽困难等级,评估外科序贯治疗的临床疗效。采用t检验或χ^(2)检验法等进行统计学分析。结果106例患儿均顺利出院。患儿均进行球囊扩张治疗,其中单纯胃镜直视下球囊扩张55例效果良好;球囊扩张联合食管黏膜下药物注射35例,其中25例效果良好,10例进行食管支架置入治疗;食管支架置入25例,其中21例效果良好,4例进行了外科手术治疗;外科手术5例效果良好。结论胃镜直视下球囊扩张、球囊扩张联合食管黏膜下注射药物、食管支架置入、外科手术的递进式个体化方法治疗儿童食管狭窄临床效果确切,方法简单,容易操作与推广。

Objective To explore the clinical efficacy of progressive individualized options for esophageal stenosis(ES)in children.Methods From January 2017 to December 2022,retrospective review was conducted for 106 ES children with regular follow-ups.There were 59 boys and 47 girls with an age range of(3.00±0.75)year and a body weight of(9.00±1.25)kg.The causes were anastomotic(n=58),corrosive(n=47)and congenital(n=1).Sequential treatments of direct balloon dilation under gastroscope,submucosal injection of drugs into esophagus,esophageal stenting and surgical procedures were applied.After interventions,degree of ES was observed by esophagography and gastroscopy along with dysphagia grade for evaluating clinical efficacy.Differences were compared by t orχ^(2) test.Results All of them were discharged uneventfully.After balloon dilatation,the outcomes were excellent under direct gastroscopic view alone(n=55).Among 35 children with balloon dilation plus esophageal submucosal drug injection,the outcomes were excellent(n=25)and esophageal stenting(n=10).Among 25 children with esophageal stenting,the outcomes were excellent(n=21)and additional surgery(n=4).Surgical procedures were performed with excellent outcomes(n=5).Conclusions The clinical outcomes progressive individualized options of direct visualization balloon dilation under gastroscope,balloon dilation plus submucosal injection of drugs into esophagus,esophageal stenting and surgical procedure are precise,convenient and efficacious for ES in children.