小儿胃食管返流的诊断与治疗探讨(附42例分析)

The experience of diagnosis and treatment of gastroephageal reflux in 42 children

目的 回顾分析小儿胃食管返流 (GER) 4 2例 ,对该病的诊断与治疗进行讨论。方法 分析不同时间段的胃食管返流病例 4 2例 ,年龄 30天～ 5岁半 ,男 33例 ,女 9例。 35例合并食管裂孔疝 ,其中 3例合并胃排空延迟 ;2例为单纯胃排空延迟 ,无食管裂孔疝 ;1例出生后即有 GER症状 ,入院时因返流性食管炎引起食管下段狭窄。根据 4 2例的治疗过程和效果对不同的诊断和手术方法进行比较。结果 胃食管钡餐是诊断 GER首选的检查 ,结果可靠 ,尤其是连续观察效果会更佳。其它检查如同位素扫描、食管下段压力测定、 2 4小时食管 p H监测等都有一定作用。非手术治疗是首选的治疗方法 ,而各类手术中以 NISSEN胃底折叠术 +幽门成型术效果最佳。结论 小儿胃食管返流需区分生理性或病理性 ,诊断方法以钡餐为首选必要时辅以其它检查即能确诊 ,无解剖结构异常者首选非手术治疗 ,手术治疗中目前公认 NISSEN胃底折叠术

Objective To review 42 gastroesophageal reflux(GER)cases in children and discuss the diagnosis and treatment for GER.Methods Analyze the case records of 42 GER patients in our hospital,the patients age ranged from 1 month to 5 5 year,33 male cases and 9 female cases.Among them 35 combined with hiatus hernia,5 suffered from delayed gastric emptying(DGE),reflux esophagitis and esophageal sricture were found in 1 case.Different diagnostic tests and treatments were employed in all patients.Results The initial and most valuable diagnostic test for evaluation of GER is the barium swallow and upper gastrointestinal series,but assistant tests,such as 24 hour pH monitoring study,ultrasonography,were necessary.Once the diagnosis of GER has been made,noneoperative treatment should be used initially,if the operative treatment is needed,Nissen fundoplication added pyloroplasty is the most effective procedure with GER.Conclusion Occasional GER occurs in everyone and is not considered abnormal,especially in young children If the GER is persistent and become serious,it is abnormal and needs treatment.Barium swallow is the best diagnostic test and Nissen fundoplication added pyloroplasty is the most effective procedure for GER. [