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安全性及有效性。方法本研究回顾性收集2017年11月1日至2018年10月31日由首都医科大学附属北京儿童医院收治的61例先天性食管闭锁术后吻合口狭窄病例作为研究对象,其中12例为本院食...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安全性及有效性。方法本研究回顾性收集2017年11月1日至2018年10月31日由首都医科大学附属北京儿童医院收治的61例先天性食管闭锁术后吻合口狭窄病例作为研究对象,其中12例为本院食管闭锁术后患儿。根据患儿辅食添加情况,将首次扩张年龄分为<3个月( n =19),3~6个月( n =12),6~12个月( n =9)和≥12个月( n =21)4组。症状缓解持续1个月以上,不需要扩张者被认为短期成功;症状缓解持续3个月以上,不需要扩张者被认为中期成功。结果61例患儿共扩张331次,单人扩张次数1~13次,扩张次数的中位数和四分位间距为5( IQR: 3~7)次。首次扩张年龄<3个月的患儿,扩张次数的中位数和四分位间距为4( IQR: 3~7)次,扩张终点球囊直径为(8.3±1.2)mm 。首次扩张年龄为3~6个月者扩张次数的中位数和四分位间距为5( IQR :3.25~7.0)次,扩张终点球囊直径为(10.1±2.0)mm 。首次扩张年龄为6~12个月者扩张次数的中位数和四分位间距为9( IQR :6.5~11.5)次,扩张终点球囊直径为(12.3±2.3)mm。≥12个月的患儿扩张次数的中位数和四分位间距为4( IQR : 2~6 )次,扩张终点的球囊直径为(13.6±1.7)mm。不同年龄组扩张次数存在统计学差异( H = 94.258 , P <0.001)。不同年龄组扩张终点球囊直径存在统计学差异( F =33.147, P <0.001)。61例患儿中,短期扩张成功率为 72.1%,中期扩张成功率为59.0%。1例发生穿孔,经保守治疗后痊愈,穿孔率为0.3%(1/331)。结论胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄,疗效满意,并发症少,可作为治疗的第一选择。展开更多
Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. The improvement of survival observed over the previous two decades is multifactorial and ...Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. The improvement of survival observed over the previous two decades is multifactorial and largely attributable to advances in neonatal intensive care, neonatal anesthesia, ventilatory and nutritional support, antibiotics, early surgical intervention, surgical materials and techniques. Indeed, mortality is currently limited to those cases with coexisting severe life-threatening anomalies. The diagnosis of EA is most commonly made during the first 24 h of life but may occur either antenatally or may be delayed. The primary surgical correction for EA and TEF is the best option in the absence of severe malformations. There is no ideal replacement for the esophagus and the optimal surgical treatment for patients with long-gap EA is still contro-versial. The primary complications during the postoperative period are leak and stenosis of the anastomosis, gastro-esophageal reflux, esophageal dysmotility, fistula recurrence, respiratory disorders and deformities of the thoracic wall. Data regarding long-term outcomes and follow-ups are limited for patients following EA/TEF repair. The determination of the risk factors for the complicated evolution following EA/TEF repair may positively impact long-term prognoses. Much remains to be studied regarding this condition. This manuscript provides a literature review of the current knowledge regarding EA.展开更多
文摘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安全性及有效性。方法本研究回顾性收集2017年11月1日至2018年10月31日由首都医科大学附属北京儿童医院收治的61例先天性食管闭锁术后吻合口狭窄病例作为研究对象,其中12例为本院食管闭锁术后患儿。根据患儿辅食添加情况,将首次扩张年龄分为<3个月( n =19),3~6个月( n =12),6~12个月( n =9)和≥12个月( n =21)4组。症状缓解持续1个月以上,不需要扩张者被认为短期成功;症状缓解持续3个月以上,不需要扩张者被认为中期成功。结果61例患儿共扩张331次,单人扩张次数1~13次,扩张次数的中位数和四分位间距为5( IQR: 3~7)次。首次扩张年龄<3个月的患儿,扩张次数的中位数和四分位间距为4( IQR: 3~7)次,扩张终点球囊直径为(8.3±1.2)mm 。首次扩张年龄为3~6个月者扩张次数的中位数和四分位间距为5( IQR :3.25~7.0)次,扩张终点球囊直径为(10.1±2.0)mm 。首次扩张年龄为6~12个月者扩张次数的中位数和四分位间距为9( IQR :6.5~11.5)次,扩张终点球囊直径为(12.3±2.3)mm。≥12个月的患儿扩张次数的中位数和四分位间距为4( IQR : 2~6 )次,扩张终点的球囊直径为(13.6±1.7)mm。不同年龄组扩张次数存在统计学差异( H = 94.258 , P <0.001)。不同年龄组扩张终点球囊直径存在统计学差异( F =33.147, P <0.001)。61例患儿中,短期扩张成功率为 72.1%,中期扩张成功率为59.0%。1例发生穿孔,经保守治疗后痊愈,穿孔率为0.3%(1/331)。结论胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄,疗效满意,并发症少,可作为治疗的第一选择。
基金Supported by Fundao de Amparo à Pesquisa do Estado de Minas Gerais, BrazilConselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil+1 种基金FAPEMIG: CBB-APQ-00075-09/ CNPq 573646/2008-2Programa de Grupos de ExcelênciaFINEP, Brazil
文摘Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. The improvement of survival observed over the previous two decades is multifactorial and largely attributable to advances in neonatal intensive care, neonatal anesthesia, ventilatory and nutritional support, antibiotics, early surgical intervention, surgical materials and techniques. Indeed, mortality is currently limited to those cases with coexisting severe life-threatening anomalies. The diagnosis of EA is most commonly made during the first 24 h of life but may occur either antenatally or may be delayed. The primary surgical correction for EA and TEF is the best option in the absence of severe malformations. There is no ideal replacement for the esophagus and the optimal surgical treatment for patients with long-gap EA is still contro-versial. The primary complications during the postoperative period are leak and stenosis of the anastomosis, gastro-esophageal reflux, esophageal dysmotility, fistula recurrence, respiratory disorders and deformities of the thoracic wall. Data regarding long-term outcomes and follow-ups are limited for patients following EA/TEF repair. The determination of the risk factors for the complicated evolution following EA/TEF repair may positively impact long-term prognoses. Much remains to be studied regarding this condition. This manuscript provides a literature review of the current knowledge regarding EA.
