结肠代食管术治疗儿童食管严重瘢痕狭窄

Colon interposition for severe cicatricial stricture of esophagus in children

目的 探讨儿童食管严重瘢痕狭窄的治疗规律及食管重建术的若干技术要点。方法 回顾分析 2 2例临床资料 ,男 16例 ,女 6例 ,年龄 3～ 13岁。病因为误服强酸、强碱、农药及烧伤。病程早期均经禁食、激素、抗生素治疗 ,并作胃或空肠造口及食管扩张术 ,最后行结肠代食管术。结果 食管改道术 2 0例 ;病变食管切除 ,结肠间置术 2例。全部治愈。 19例随访 1～ 16年 ,患儿生长、发育、进食与同龄儿童无异。 2例并发胸结肠淤滞综合征。结论 结肠代食管术为治疗儿童食管严重瘢痕狭窄的理想方法。取结肠左动脉供血、横结肠顺蠕动向、经前纵隔上提作结肠与下咽或颈食管端端吻合术。术后长期生存质量优良。

Objective This study reviews the technicalities of surgical treatment of severe cicatricial stricture of esophagus in children.Methods The management of 22 patients with severe cicatricial stricture of esophagus were reviewed. There were 16 boys and 6 girls, with age ranging from 3 to 13 years. The cause of esophageal stricture was accidental ingestion of corrosive substances. The patients were put on nil by mouth, hormone, and antibiotics therapy at the initial stage. Meanwhile, some patients underwent gastrostomy, jejunostomy or dilation of esophagus. Esophagus reconstruction with colon was performed eventually. The left colic artery was used as the feeding vessel. Iso-peristaltic anastomosis of the transverse colon to hypopharynx was achieved. Results Twenty patients underwent esophageal bypass and 2 underwent resection of the diseased esophagus and colonic replacement. All 22 patients recovered well. There was no difference of growth, development and diet between these 22 children and the age-matched controls after 1～16 years follow-up. Two patients developed thoracic colon stasis.Conclusions Colon replacement of esophagus is an ideal method for treating severe cicatricial stricture of esophagus in children.