球囊扩张术在小儿食道狭窄及贲门失弛缓中的应用分析  

Endoscopic balloon dilatation of esophageal stricture and esophageal achalasia in children

作　　者：代东伶[1] 蔡华波[1] 周少明[1] 罗贤泽 Dong-ling Dai;Hua-bo Cai;Shao-ming Zhou;Xian-ze Luo(Department of Gastroenterology, Shenzhen Children’s Hospital, Shenzhen, Guangdong 518038, China)

机构地区：[1]广东省深圳市儿童医院消化内科,广东深圳518038

出　　处：《中国内镜杂志》2017年第8期71-76,共6页China Journal of Endoscopy

摘　　要：目的比较球囊扩张术(EBD)治疗小儿食道狭窄及贲门失弛缓的疗效,分析预后影响因素。方法 2012年1月-2014年12月共28例患儿纳入研究。其中,食道狭窄22例,贲门失弛缓6例,利用扩张球囊进行治疗。结果 28例患儿共接受57次球囊扩张术,随访12~36个月,28例全部成功。其中,23例患儿症状完全缓解(82.14%),4例患儿部分缓解(14.28%),1例无效(3.57%),1例复发(3.57%)。治疗成功率、有效率、并发症发生率及复发率两组患儿比较差异无统计学意义。食道狭窄患儿中,多个狭窄患儿并发症较单个狭窄患儿多,狭窄直径越小并发症越多,比较差异有统计学意义(P<0.05);治疗效果与狭窄直径和狭窄个数显著相关(P<0.05)。贲门失弛缓组患儿中,发病年龄及明确诊断前症状持续的时间均对EBD治疗效果没有显著影响。结论 EBD是小儿食道狭窄及贲门失弛缓安全有效的治疗手段;狭窄直径和狭窄个数是影响食道狭窄治疗效果最重要的因素,而第一次球囊扩张与食道闭锁手术之间的时间则是术后食道狭窄患儿最重要的影响因素。Objective To assess the safety,effectiveness and predictive factors of endoscopic balloon dilatationfor the treatment of esophageal stricture and esophageal achalasia in children.Methods28patients with esophagealstricture and esophageal achalasia treated by endoscopic balloon dilatation from January2012to November2014were included.All the patients were divided into two groups,22in group A(esophageal stricture)and6in group B(esophageal achalasia).All procedures were performed under tracheal intubation and intravenous anesthesia using the3rd grade controlled radial expansion(CRE)balloon with gastroscope.Outcomes,including success,complicationsand recurrence data were recorded,and predictors for outcomes were analyzed.Results A total of EBD57sessions(1to5per patient,2.00±1.15)were performed on28patients in this study.22patients were diagnosed withesophageal stricture(78.57%)and6with esophageal achalasia(21.43%).The median age was25months(range0~150),and female/male ratio was12/16.EBD was successful in all the28cases.The total success rate was100.00%.Complications occurred in6patients during the dilatation,and no complication in22patients.Completely remission of symptoms was seen in82.14%cases(n=23),relief in14.28%(n=4),non-response in3.57%(n=1),and recurrence in3.57%(n=1).The stricture diameter before EBD was(6.28±1.77)mm(range3.0~10.0mm),and it was(10.85±2.51)(range6~15mm)after the last EBD.The difference was significant(P<0.01).There wasno significant difference in success,effectiveness,complications and recurrence among the two groups(P>0.05).The effectiveness of EBD was significantly associated with the diameter and number of strictures(P<0.05),morecomplications were seen in the patients with multiple and/or smaller strictures(P<0.05).In group A,the longerinterval between surgery and the first EBD was related to more dilatation in the patients with anastomotic esophagealstrictures(P<0.05).The age and the interval between symptom onset and the first EBD were not the predictingfactors for treatment in group B(P

关 键 词：食管狭窄 气囊扩张术 贲门失弛缓 

分 类 号：R571.1[医药卫生—消化系统] R573.7[医药卫生—内科学]