食管闭锁术后吻合口狭窄的治疗体会  

Experience in the treatment of anastomotic stenosis after surgery for esophageal atresia

作　　者：刘智文[1] 陶俊峰[1] 陈快[1] 樊纬[1] 黄金狮[1] 陶强[1] LIU Zhiwen;TAO Junfeng;CHEN Kuai(Department of Neonatal Surgery,Jiangxi Children’s Hospital,Nanchang 330006,China.)

机构地区：[1]江西省儿童医院新生儿外科,南昌330006

出　　处：《江西医药》2019年第1期15-17,39,共4页Jiangxi Medical Journal

摘　　要：目的探讨先天性食管闭锁患儿胸腔镜食管重建术后吻合口狭窄的治疗经验。方法收集2013年1月-2017年12月收治的26例行胃镜下沙氏探条扩张的食管闭锁术后吻合口狭窄的患儿临床资料,以扩张后的临床表现和钡餐造影为标准(其中扩张后超过6个月无呕吐、痰多、吞咽困难等临床症状,造影显示吻合口基本无狭窄诊断为治愈;扩张后仍偶有临床症状,复查造影显示吻合口轻微狭窄,但未达到需扩张治疗标准为有效;患儿年龄>1岁,扩张次数>12次,临床症状反复出现,且缓解期<1个月,诊断为失败)评价吻合口狭窄的发生发展及探条扩张治疗食管闭锁胸腔镜手术后吻合口狭窄的临床疗效。结果 26例患儿共扩张143次,平均5.5次/例;扩张间隔频率3.5d-3个月,平均27d/次。扩张时无食管破裂及大出血等并发症。共随访2～48个月,其中18例治愈,6例有效,2例失败后再次行瘢痕段切除+食管重建。24例有效、治愈患儿中,2例中度营养不良,7例身高体重稍低于同龄儿童,余患儿生长发育状况良好。结论吻合口狭窄的诊治是食管闭锁术后续贯治疗的关键,探条扩张技术能改善吻合口狭窄程度,效果满意,安全、有效。Objective To explore the criteria for diagnosis and treatment of anastomotic stricture after thoracoscopic esophageal reconstruction in children with congenital esophageal atresia.Methods To collect the clinical data of 26 children with anastomotic stenosis after esophageal atresia treated with Shaw's probe dilation under gastroscope from January 2013 to December 2017.According to the clinical manifestations and barium meal radiography after dilatation(no vomiting,phlegm,dysphagia and other clinical symptoms were found after dilatation for more than 6 months,barium meal radiography showed that the anastomotic stoma was basically cured without stenosis;there were still occasional cough and vomiting symptoms after dilatation,but repeated barium meal radiography within 6 months showed slight stenosis of the anastomotic stomotic stoma,and the stenosis index did not meet the criteria for dilatation.The diagnosis was effective;the patient was older than 1 year old,dilated more than 12 times,vomiting,coughing and other symptoms recurred repeatedly,and the remission period was less than 1 month,repeated pulmonary infection occurred,diagnosis was failure.)To evaluate the development of anastomotic stenosis and the clinical efficacy of stretch dilation in the treatment of anastomotic stenosis after thoracoscopic surgery for esophageal atresia.Results Twenty-six children were dilated 143 times,averaging 5.5 times per case;the frequency of dilation interval was 3.5 days to 3 months,averaging 27 days per time.There were no complications such as esophageal rupture and massive hemorrhage during dilation.A total of 2 to 48 months of follow-up were carried out.Among them,18 cases were cured,6 cases were effective,and 2 cases were treated with scar segment resection and esophageal reconstruction after failure.Of the 24 effective and cured children,2 were moderately malnourished,7 were slightly lower in height and weight than their peers,and the rest were in good growth and development.Conclusion Standard follow-up is the key to th

关 键 词：先天性食管闭锁 吻合口狭窄 探条扩张 

分 类 号：R726.5[医药卫生—儿科]