单中心儿童食管狭窄外科综合治疗经验  

Surgical comprehensive treatments for pediatric esophageal strictures

作　　者：唐悦 雷洪波[1] 金鑫[1] 李洪波[1] 王刚[1] 代江涛[1] 潘征夏[1] 吴春[1] 李勇刚[1] Tang Yue;Lei Hongbo;Jin Xin;Li Hongbo;Wang Gang;Dai Jiangtao;Pan Zhengxia;Wu Chun;Li Yonggang(Department of Cardiothoracic Surgery,Affiliated Children's Hospital,Chongqing Medical University,National Clinical Research Center for Children's Health&Disorders,Ministry of Education Key Laboratory of Children's Development&Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 401144,China)

机构地区：[1]重庆医科大学附属儿童医院胸心外科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆401144

出　　处：《中华小儿外科杂志》2023年第9期794-799,共6页Chinese Journal of Pediatric Surgery

基　　金：重庆市医学科研项目(2016ZDXM013)。

摘　　要：目的总结儿童食管狭窄的外科诊治经验,探讨儿童食管狭窄的处理策略。方法回顾性分析2012年12月至2023年1月重庆医科大学附属儿童医院胸心外科收治的297例食管狭窄患儿的临床资料,其中男196例,女101例;首诊年龄中位数为3.8(1.7,32.8)个月;首诊食管手术后食管狭窄164例,创伤后食管狭窄59例,食管壁内气管支气管软骨残留30例,纤维肌性食管狭窄10例,贲门失弛缓症16例,食管裂孔疝术后食管狭窄5例,反流性食管炎伴食管狭窄7例(包含Barrett食管2例),外压性食管狭窄(伴血管环)5例,大疱性表皮松解症伴食管狭窄1例。诊治患儿定期随访,收集患儿治疗方式及治疗结局等信息。结果进行食管注射治疗3例,食管扩张230例,食管支架5例,手术治疗59例。治疗结果为治愈120例,治疗有效177例,无死亡病例。总体治愈率40.4%(120/297),有效率59.6%(177/297)。结论儿童食管狭窄需多因素评估后制定个体化综合处理方案,可取得良好治疗效果。多学科治疗模式和微创精确手术可能是未来小儿食管狭窄的治疗方向。Objective To summarize the experiences of diagnosing and treating pediatric esophageal strictures and to explore optimal strategies for managing pediatric esophageal strictures.Methods From December 2012 to January 2023,the relevant clinical data were retrospectively reviewed for 297 children hospitalized with esophageal strictures.There were 196 boys and 101 girls with a median age of 3.8(1.7,32.8)months at an initial diagnosis.During regular follow-ups,treatments and outcomes were recorded.Among 164 cases(55.2%)of postoperative esophageal strictures,the causes were trauma(n=59,19.9%),residual tracheobronchial cartilage in esophageal wall(n=30,10.1%),fibromuscular hypertrophy(n=10,3.4%),achalasia(n=16,5.4%),after hiatus hernia surgery(n=5,1.7%)and reflux esophagitis(n=7,2.4%).The latter included Barrett's esophagus(n=2)and extrinsic with vascular rings(n=5).One case was due to bullous epidermolysis.Results There were 3 esophageal injections,230 probe dilatations,5 esophageal stenting and 59 operations.And 120 cases were cured.There were 177 effective cases and no mortality.Overall therapeatic rate was 40.4%and effective rate 59.6%.Conclusions For pediatric esophageal strictures,individualized comprehensive treatments should be formulated after a comprehensive evaluation of multiple factors.Multidisciplinary treatments,minimally invasive approach and precision surgery are future trends for pediatric esophageal strictures.

关 键 词：食管狭窄 手术治疗 儿童 

分 类 号：R726.5[医药卫生—儿科]