婴幼儿食管瘢痕狭窄的外科治疗

Surgical treatment of cicatricial esophageal stenosis in infants

目的 回顾性分析婴幼儿食管良性狭窄 3 0例外科治疗结果。探讨外科治疗各种方法的优劣。方法 3 0例中男 2 0例 ,女 1 0例 ,年龄 1岁 5个月～ 5岁 ,平均 2 9个月。体重 5～2 0kg。除 1例为农药烧伤外 ,余均为误服强酸、碱烧伤。颈段食管完全闭塞 3例 ,基本闭塞 5例 ,余食管造影均见钡剂在食管全长呈不规则线样通过、其中 5例伤后曾有时间不等声嘶及吸气性呼吸困难 ,6例在外院行胃造瘘 ,全部病例采用保留结肠左动脉升支供血 ,经胸骨后径路顺蠕动吻合横结肠代食管结肠颈部吻合或结肠咽吻合。结果 手术后颈部吻合口瘘 1例 ,吻合口狭窄1例。术后气管切开 1例 ,经治疗后顺利进食 ,无手术死亡。径 4～ 2 0余年随访 ,患儿发育正常。结论 主张对的食管瘢痕狭窄应积极采取食管重建术。食管替代物中以横结肠为最佳。同期食管瘢痕切除食管的危险性大 ,手术应以食管旷置为佳。重建平面需在颈部或咽部 。

Objective To review the results of surgical management of cicatricial esophageal stenosis secondary to chemical burn.Methods Retrospective study was carried out on 30 children (male 20, female 10 ) with esophageal cicatricial stenosis. The mean age was 29 months (17 to 60 months) and body weight ranged from 5 to 20 kilograms. One child ingested pesticide whereas the remaining ingested acidic or caustic solutions. Three children had complete obliteration of cervical esophagus, 5 had near complete obliteration and the remaining showed stringy esophageal outline on barium meal study. Five children developed stridor and inspiratory dyspnea. Six children had previous gastrostomy. All patients underwent retrosternal colonic replacement based on left ascending colonic artery.Results Post operatively, one patient developed anastomotic leakage and one anastomotic stenosis. One patient underwent a post-operative tracheostomy. There was no mortality. All patients were followed up for 4-20 years with normal development.Conclusions Colonic replacement offers the best treatment of esophageal stenosis secondary to chemical burn. One stage esophagectomy is dangerous and esophagocolostomy is preferred. The anastomosis should be performed at the cervical level.