内镜下放射状切开术治疗儿童十二指肠隔膜狭窄13例临床分析(含视频)  

Clinical analysis of 13 cases of pediatric membranous duodenal stenosis treated with endoscopic radial incision(with video)

作　　者：任晓侠[1] 杨洪彬[1] 葛库库 张含花[1] 刘欢宇 王潘 孙丽娜 周平红 方莹[1] Ren Xiaoxia;Yang Hongbin;Ge Kuku;Zhang Hanhua;Liu Huanyu;Wang Pan;Sun Lina;Zhou Pinghong;Fang Ying(Department of Gastroenterology,Xi'an Children's Hospital,Xi'an 710003,China;Endoscopy Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]西安市儿童医院消化内科,西安710003 [2]复旦大学附属中山医院内镜中心,上海200032

出　　处：《中华消化内镜杂志》2024年第1期58-64,共7页Chinese Journal of Digestive Endoscopy

基　　金：西安市儿童医院院级项目特别项目(2020A01);N^(3)雀巢临床营养学院2022年科研基金(MN3-20220807-2)。

摘　　要：目的探讨内镜下放射状切开术(endoscopic radial incision,ERI)治疗儿童先天性十二指肠隔膜狭窄(membranous duodenal stenosis,MDS)的有效性及安全性。方法回顾性分析2017年5月至2021年12月西安市儿童医院消化内科收治的13例接受ERI治疗的MDS患儿的临床资料,分析手术过程、术后并发症及随访情况。结果13例MDS患儿中男5例,女8例,中位病程时间8个月(2~20个月),中位诊断月龄13个月(5~30个月)。隔膜位于十二指肠降部10例(10/13),水平部3例(3/13)。十二指肠乳头开口于隔膜上1例(1/13),隔膜口侧5cm内3例(3/13),隔膜肛侧5cm内9例(9/13)。隔膜中位孔径为3mm(2~6mm)。13例患儿均顺利完成ERI,中位手术时间20min(15~32min)。手术平均切开3刀(2~4刀),术后外径9.9mm内镜可自由通过,切开中位直径10mm(10~12mm),术后临床症状均达到缓解。术后出现并发症1例(1/13),为切口迟发性出血,内镜下金属夹夹闭止血,无肠穿孔及十二指肠乳头损伤等并发症。术后中位住院时间为6d(5~10d)。术后3个月复查上消化道造影及胃镜,狭窄口中位直径12mm(10~15mm),较术前狭窄口明显扩张。术后1个月患儿体重比术前平均增加1.20kg(0.50~1.80kg),术后3个月患儿体重平均增加3.50kg(2.50~4.00kg),接近正常同龄儿标准体重。结论ERI作为微创方法治疗儿童MDS安全有效,具有良好的临床应用及推广价值。Objective To explore the efficacy and safety of endoscopic radial incision(ERI)for congenital membranous duodenal stenosis(MDS).Methods The clinical data of 13 children with MDS receiving ERI in the Department of Gastroenterology of Xi'an Children's Hospital from May 2017 to December 2021 were reviewed and analyzed.The perioperative management,surgical procedures,postoperative complications and follow-up were summarized.Results There were 5 boys and 8 girls with a median disease duration of 8(2-20)months,and the median age of diagnosis was 13 months(5-30 months).The septum of 10 cases(10/13)was located in the descending part of the duodenum,and that of 3 cases(3/13)in the horizontal part.The papilla of 1 case(1/13)opened on the septum,that of 3 cases(3/13)within 5 cm of the mouth side of the septum,and that of 9 cases(9/13)within 5 cm of the anal side of the septum.The median diameter of the septal aperture was 3 mm(2-6 mm).All 13 children successfully underwent ERI with a median operation time of 20 min(15-32 min).The average surgical incision was 3 strokes(2-4 strokes),and the endoscope with outer diameter 9.9 mm could pass stenosis after ERI.The median incision diameter was 10 mm(10-12 mm).All patients achieved relief of clinical symptoms after ERI.One patient(1/13)suffered from the postoperative delayed bleeding,which was stopped by endoscopic titanium clamping.No intestinal perforation or duodenal papilla injury occurred,and median postoperative hospital stay was 6 days(5-10 days).The upper gastrointestinal angiogram and gastroscopy were repeated 3 months after ERI,and the median diameter of stenosis was 12 mm(10-15 mm),which was significantly dilated compared with before.The mean body weight increase at 1 month after ERI was 1.20 kg(0.50-1.80 kg),and the mean body weight increase at 3 months was 3.50 kg(2.50-4.00 kg),which reached the normal body weight of the same age.Conclusion ERI is safe and effective for the treatment of MDS in children,and shows good clinical application and promotion value.

关 键 词：十二指肠梗阻 儿童 十二指肠隔膜狭窄 内镜下放射状切开术 

分 类 号：R726.5[医药卫生—儿科]