儿童贲门失弛缓症21例诊治分析  

Diagnosis and treatment of esophageal achalasia in twenty-one children

作　　者：宁慧娟[1] 张艳玲[1] 李龙[1] 钟雪梅[1] 孔赤寰[1] 金萌[1] 宫幼喆[1] 马昕[1] 朱丹[1] 

机构地区：[1]首都儿科研究所附属儿童医院消化内科,北京100020

出　　处：《北京医学》2016年第8期795-797,801,共4页Beijing Medical Journal

摘　　要：目的探讨儿童贲门失弛缓症的临床特点及治疗方法。方法分析我院2008年6月至2016年3月确诊的21例贲门失弛缓症患儿的临床表现、检查及治疗情况。结果男15例,女6例,就诊时年龄7个月至16岁9月,病程40 d至4年,呕吐和吞咽困难是最多见的症状,其次为咳嗽、反酸、胸骨后疼痛、体重增长缓慢等。根据临床表现,结合消化道造影、电子胃镜、食管高分辨测压等诊断,治疗包括口服硝苯地平、胃镜下食管球囊扩张术和经口内镜下食管括约肌切开术(POEM)、开胸及腹腔镜下食管下段肌层切开术(Heller手术)。结论消化道造影是诊断本病的主要方法,食管高分辨测压可对本病进行分型和手术疗效评估,腹腔镜下Heller手术+胃底折叠术和POEM术损伤小、恢复快、手术效果显著,是本病较好的治疗方法。Objective To explore the clinical manifestations and therapeutic approaches in children diagnosed as esophageal achalasia. Methods Twenty-one children diagnosed and hospitalized between June 2008 and March 2016 were included. The clinical manifestations, data of laboratory tests and treatment regimen were analyzed. Results Fifteen boys and six girls aged from seven months to sisteen years and nine months were included. The course was from forty days to four years. Dysphasia and vomiting were the most frequent symptoms in the affected children. Cough, sour regur- gitation, retrosternal pain and poor growth were presented in some cases. The clinical manifestations, electronic gastrosco- py, gastrointestinal radiography combined with Esophageal High-Resolution Manometry were based to diagnose esopha- geal achalasia of children. The therapeutic approaches included oral drug therapy, pneumatic dilation, peroral endoscopic myotomy（POEM）, Heller esophagocardiomyotomy. Conclusion Gastrointestinal radiography has been proven to be a primary diagnostic method. By observing esophageal motility directly, HRM can become an appropriate test for diagnosis, classification and outcome assessment. Heller esophagocardiomyotomy and POEM have been proven to be a better treatment approach due to its minor injury after surgery, fast recovery and effectiveness.

关 键 词：贲门失弛缓症 吞咽困难 食管下段肌肉切开术(Heller手术) 经口内镜下食管括约肌切开术(POEM) 

分 类 号：R725.7[医药卫生—儿科]