小儿胃食管反流的诊断与治疗  

Diagnosis and Treatment of Gastroesophageal Reflux in Children

作　　者：蒋小平[1] 胡廷泽[1] 

机构地区：[1]华西医科大学附属第一医院小儿外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2000年第2期120-123,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：小儿胃食管反流 (GER)是由于小儿食管下端功能障碍引起的胃内容物及十二指肠内容物反流入食管。其常见并发症有反流性食管炎、食管狭窄和上消化道出血等 ,临床特征为顽固性呕吐或反胃 ;胸骨后烧灼感或疼痛、吞咽困难和呕血 ;反复发作的肺炎、支气管炎、哮喘和窒息等。检查方法可采用胃食管 X线钡餐造影 ,2 4小时食管 p H监测 ,放射性核素食管显像 ,食管内窥镜及组织活检 ,食管下端压力测定等。后 4项指标不仅用于诊断胃食管反流 ,还可判断治疗是否有效。应用抗酸剂、胃粘膜保护剂和 H2 受体拮抗剂等治疗 6～ 12周无效时 ,则应用手术治疗。随着微创手术引入小儿外科 ,小儿腹腔镜胃底部分折叠术 (180°)及腹腔镜幽门成形术由于手术效果好、创伤小、恢复快、术后并发症少等优点 ,而逐渐替代原传统经腹 Nissen胃底折叠术 (36 0°) ,其远期疗效有待观察。但它为小儿胃食管反流的治疗开辟了一条新的途径。Gastroesophageal reflux(GER) in children is defined as the gastric and duodenal contents refluxing into esophagus duo to afunction of low esophageal sphincter. Its complications are reflux esophagitis, esophagostenosis, esophageal bleeding and so on. The symptoms of GER include regurgitation, heartburn, infant irritation, dysphagia, hemorrhage, stricture, malnutrition, aspiration, apnea, anaemia and so on. The diagnostic tests compose of barium esophagram, ambulatory 24 hours esophageal pH monitoring in two level, gastric isotope emptying study, lower esophageal sphincter pressure manometry and esophagoscopy with biopsy. The latter 4 tests are not only applied for diagnosis of GER, but also used to assess the efficacy of treatment.Drug treatment can be subdivided into antacids, H 2 receptor antagonists, cytoprotective agents prokinetics and proton pump inhibitors. With noninvasive operations being used in pediatric surgery, laparoscopic anterior fundoplication(180°) and laparoscopic gastric antroplasty (in children with delayed gastric emptying) are taking the place of conventional open Nissen fundoplication(360°) in treatment of GER because it achieved equivalent control of reflux, more physiological postoperative manometry parameters, and a better clinical outcome, with fewer postoperative complications and safer and rapid recovery. Continued follow up remains necessary to confirm the long term efficacy of the partial fundoplication procedure.

关 键 词：儿童 胃食管反应 诊断 治疗 

分 类 号：R726.5[医药卫生—儿科]