内镜黏膜下剥离术在儿童十二指肠膜式狭窄治疗中的应用研究  

Clinical application of Endoscopic Submucosal Dissection in the treatment of children with duodenal membrane stenosis

作　　者：汪星[1] 刘海峰[1] 叶国刚[1] 顾竹珺[1] 盛庆丰[1] 林凯[1] 冯玉灵 Wang Xing;Liu Haifeng;Ye Guogang;Gu Zhujun;Sheng Qingfeng;Lin Kai;Feng Yuling(Department of Digestive Endoscopy Center,Shanghai Children's Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院上海交通大学附属儿童医院消化内镜中心,200062

出　　处：《中华小儿外科杂志》2021年第11期980-984,共5页Chinese Journal of Pediatric Surgery

基　　金：上海市卫生健康委员会科研课题项目(201840341、20194Y0139)。

摘　　要：目的分析和探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)在儿童十二指肠膜式狭窄治疗中的疗效及临床意义。方法回顾性分析2017年10月至2019年12月间上海市儿童医院采用ESD技术进行手术治疗的5例十二指肠膜式狭窄患儿的临床资料。其中,男2例,女3例;年龄8月龄至2岁;十二指肠乳头位于隔膜上方者3例,位于隔膜下方者2例。十二指肠乳头位于隔膜上方者在保护乳头前提下直接行ESD切除治疗;十二指肠乳头位于隔膜下方者在球囊扩张完成后使用超细内镜探查乳头开口位置,确定位置后再行ESD切除治疗。术后定期随访,观察患儿临床症状改善情况,体重增长变化及有无术后并发症等。结果5例患儿手术均成功施行,术中及术后无出血、穿孔等并发症发生。术后随访5~26个月,患儿可正常进食,无呕吐、腹胀及皮肤巩膜黄染表现。5例患儿术前体重为(6.78±1.39)kg,术后3个月时体重为(9.34±1.68)kg,体重平均较前增长38.5%,生长发育逐渐恢复正常。结论采用ESD切除十二指肠隔膜具有安全性高、临床效果良好、创伤小及恢复快等特点,值得在儿外科临床应用。Objective To investigate treatment efficacy,operating method and clinical value of using Endoscopic Submucosal Dissection(ESD)technique to treat duodenal membrane stenosis in children.Methods Retrospective data analysis was performed for 5 children with duodenal membrane stenosis from October 2017 to December 2019,they underwent resection of duodenal diaphragm by ESD technique in our hospital,including 2 males and 3 females aged from 8 months to 2 years old,3 cases had duodenal papilla above the diaphragm while 2 cases had duodenal papilla below the diaphragm.For cases with duodenal papilla above the diaphragm,ESD resection was directly performed.While for cases with duodenal papilla below the diaphragm,ESD resection was performed only after balloon dilation was conducted and the duodenal papilla position was explored by ultrafine endoscope.The improvement of clinical symptoms,body weights and postoperative complications were recorded and analyzed during regular follow-ups.Results All the 5 cases were successfully treated by endoscopic treatment.No bleeding,perforation and other complications occurred during and after the operation.During a follow-up period of 5-26 months,children could eat normally without vomiting,abdominal distension and jaundice.Their body weights increased by 38.5%on average[mean preoperative weight(6.78±1.39)kg,mean postoperative body weight 3 months after surgery(9.34±1.68)kg],and the growth and development of them gradually turned to normal.Conclusions Using ESD technique to treat duodenal diaphragm is both safe and reliable in children,with the advantages of significant curative effect,minimal trauma and rapid recovery,Which is worthy of wider clinical application in pediatric surgery.

关 键 词：儿童 十二指肠隔膜 内镜黏膜下剥离术 

分 类 号：R726.5[医药卫生—儿科]