改良式球囊持续扩张替代支架置入治疗儿童良性食管狭窄  

Modified continuous balloon dilatation substituting stenting in the treatment of benign esophageal stenosis in children

作　　者：刘新献[1] 黄穗[2] 刘帆[2] 周福祥[1] 

机构地区：[1]武汉大学中南医院放化疗中心,430071 [2]武汉市妇女儿童医疗保健中心影像中心

出　　处：《中华放射学杂志》2015年第12期922-926,共5页Chinese Journal of Radiology

摘　　要：目的探讨改良式球囊持续扩张替代传统覆膜食管支架治疗儿童良性食管狭窄的可行性。方法回顾性分析2012年1月至2014年2月收治的25例食管狭窄患者的临床资料。所有患者术前经食管造影确诊，明确狭窄部位及长度。术后2～4周影像复查狭窄段扩张情况。依据食管狭窄发生的部位及年龄将25例患者分为A、B组。A组12例，年龄及食管狭窄段无明显球囊持续扩张禁忌证，行球囊持续扩张治疗；B组13例，年龄〈3岁、食管上段狭窄不宜行支架置入术，行可取m式覆膜支架置入术。患者术后第1、4、10个月各随访1次，然后每6个月随访1次，随访时间6个月至2年，随访患者的临床症状、进食情况以及食管狭窄段的扩张程度，并以此评价疗效。结果2组患者均成功置入球囊或支架，治疗2～4周后支架顺利取出，治疗前后狭窄段平均直径明显增加[治疗前A组（3．80±1．98）mm、B组（3．10±1．28）mm，治疗后A组（9．50±2．18）、B组（8．90±1．53）mml，吞咽困难均得到明显改善，未发生穿孔、呕血及黑便等较严重并发症。A组1例发生球囊下移，在透视下进行调整；1例因反复再狭窄行结肠代食管手术治疗，有效10例。B组5例发生支架脱落、移位，3例发生食管再狭窄，有效5例。A组并发症发生率少于B组，差异有统计学意义（χ^2=5．23，P〈0．05）。结论球囊持续扩张术在治疗儿童良性食管狭窄方面较支架置入术操作简单、并发症少、疗效确切，是继支架置入术之后的又一理想选择。Objective To explore the feasibility of using the modified continuous balloon dilatation substituting the traditional membrane-covered stent in the treatment of benign esophageal stenosis in children. Methods A retrospective analysis of the clinical data of 25 eases with esophageal stenosis from January,2012 to February,2014 was conducted. Preoperative esophageal stenosis was confirmed by angiography, and the expansion of the stenosis segment was examined after 2-4 weeks postoperatively. According to the age and the location of the esophageal stricture, 25 cases were classified into two groups. Twelve cases of group A without obvious contraindications were treated by continuous balloon dilatation, while 13 cases of group B with age of less than 3 years or upper esophageal stenosis, retrievable stent implantation was performed. All cases were followed up frmn 6 months to 2 years. Clinical symptoms, swallowing fluency and the degree of esophageal stricture were followed up at 1, 3, and 6 months postoperatively, and the effect of treatment was evaluated. Results Two groups of patients were successfully treated, and the stents were removed successfully after 2-4 weeks. The average diameter of the stenosis was significantly increased after treatment, swallowing was improved obviously, with no perforation, hematemesis and melena and other serious complications. The balloon moved down happened in one case, which was adjusted under perspective observation. One case in group A underwent colonic interposition for esophageal replacement because of recurrence of restenosis. The balloon dilatation was effective in 10 cases.In Group B, 5 patients had stent migration or displacement, 3 cases had recurrent esophageal stricture, and the treatment was effective in 5 cases. There was significant difference in complications between the group A and B （χ^2=5.23, P〈0.05）.Conelusions Continuous balloon dilatation is a simple, effective procedure with fewer complications in the treatment of children with benign esophageal stenosis

关 键 词：食管狭窄 支架 儿童 

分 类 号：R726.5[医药卫生—儿科]