吻合口狭窄指数及狭窄处食管直径对内镜下球囊扩张治疗食管狭窄的诊疗意义  

Significance of anastomotic stenotic index and esophageal diameter for managing stenosis during endoscopic balloon dilatation

作　　者：廖俊敏 杨深 张雅楠[1] 赵勇 谷一超 华凯云 李思琪 黄金狮 Liao Junmin;Yang Shen;Zhang Yanan;Zhao Yong;Gu Yichao;Hua Kaiyun;Li Siqi;Huang Jinshi(Department of Neonatal Surgery,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院新生儿外科,100045

出　　处：《中华小儿外科杂志》2021年第5期385-391,共7页Chinese Journal of Pediatric Surgery

摘　　要：目的探究食管闭锁术后吻合口狭窄患儿开始进行胃镜下球囊扩张术后半年食管造影测量的吻合口狭窄指数(stricture index,SI)及狭窄处食管直径(stricture diameter,SD)的变化及诊疗意义。方法回顾性分析2017年11月至2019年8月北京儿童医院新生儿外科收治的食管闭锁术后因吻合口狭窄开始行电子胃镜下球囊扩张治疗60例患儿的病例资料。其中,男34例(56.7%),女26例(43.3%);首次扩张年龄为(7.98±8.88)个月,范围为0.9~40个月。收集开始扩张治疗前食管造影和半年复查食管造影的影像学资料及2次造影中间扩张次数等相关信息,采用配对t检验比较2次造影的SD、吻合口狭窄指数(D取狭窄上)(upper pouch-stricture index,U-SI)、吻合口狭窄指数(D取狭窄下)(lower pouch-stricture index,L-SI)的变化。根据是否达到中期成功(>3个月无须再次扩张或手术治疗)将样本分为成功组(45例)和未成功组(15例),通过卡方检验、独立样本t检验、Mann-Whitney U秩和检验比较两组基线特征。采用多因素Logistic回归分析预测诊断扩张是否达到成功的独立因素,并对独立因素进行受试者工作特征(receiver operating characteristic,ROC)曲线分析。结果半年内扩张治疗达到中期成功患儿45例(75.0%),未在半年内达到中期成功患儿15例(25.0%)。总扩张次数为450次,中位数为6次。配对t检验发现,扩张前SD、U-SI和L-SI分别为(3.028±2.024)mm、(76.488±17.928)%和(66.864±17.300)%与扩张后(5.964±3.121)mm、(47.018±21.617)%和(43.470±19.194)%比较,差异均有统计学意义(P均<0.001)。多因素Logistic回归分析发现,半年内扩张次数(OR=0.554,P=0.002)和半年时造影的U-SI(OR=0.000239,P=0.019)是预判半年内是否达到成功的独立因素,且扩张次数(AUC=0.92,P<0.001)和U-SI(AUC=0.83,P<0.001)在预判半年内扩张是否达到成功上效能较高,两者的临界值分别为10.5和55.6%。结论食管闭锁术后吻合口狭窄患儿经过多次�Objective To explore the changes of stricture index(SI)and stricture diameter(SD)on esophagography within 6 months after endoscopic balloon dilatation in children with esophageal anastomotic stricture after repairing esophageal atresia(EA).Methods From November 2017 to August 2019,retrospective reviews were conducted for medical records of children undergoing endoscopic balloon dilatation after EA repair.There were 34 boys(56.7%)and 26 girls(43.3%)with an average initial dilatation age of 7.98(0.9-40)months.The imaging data of esophagography pre-dilatation and within 6 months post-dilatation and the number of dilatations during the period were recorded.Then the changes of SD,upper pouch-stricture index(U-SI)and lower pouch-stricture index(L-SI)on esophagography were analyzed by paired sample T test;the samples were divided into success or non-success groups according to whether there was medium-term success(>3 months)without dilatations.Baseline characteristics of two groups were compared by Chi-square test,independent sample t-test and Mann-Whitney U test.Multivariate Logistic regression analysis was performed for predicting the independent factors for the success of diagnosis dilatation.Receiver operating characteristic(ROC)curve was utilized for analyzing the independent factors.Results Finally 45 cases(75.0%)achieved a medium-term success while 15 cases(25.0%)failed within 6 months.The total number of dilatation was 450 with a median value of 6.Paired sample T test indicated that significant differences existed in SD(3.028±2.024)mm,U-SI(76.488±17.928)%and L-SI(66.864±17.300)%pre-dilatation as compared with SD(5.964±3.121)mm,U-SI(47.018±21.617)%and L-SI(43.470±19.194)%post-dilatation.Logistic regression analysis revealed that the number of dilatations(OR=0.554,P=0.002)and U-SI(OR=0.000239,P=0.019)were independent factors for predicting the success of dilatations within 6 months;the number of dilations(AUC=0.92,P<0.001)and U-SI(AUC=0.83,P<0.001)had a high efficiency of predicting the success of dilatation

关 键 词：食管闭锁 儿童 胃镜下球囊扩张术 回归分析 

分 类 号：R726.5[医药卫生—儿科]