内镜下治疗儿童食管良性狭窄24例报告

发布时间：2018-06-25 15:56

本文选题：食管 + 良性狭窄　；参考：《广西医科大学》2012年硕士论文

【摘要】：目的：探讨内镜治疗小儿食管良性狭窄三种扩张方式的疗效及差异方法：收集广西医科大学第一附属医院2001年1月至2011年11月2日24例小儿食管良性狭窄患者,通过胃镜及上消化道钡餐明确食管狭窄性质,部位及程度,对其进行回顾性分析,24例患者均行内镜下球囊、水囊或探条扩张术,比较患者扩张前后吞咽困难评分,胃镜下狭窄直径和扩张次数,进行统计学分析比较,评价三种扩张方式疗效,并对其进行随访。结果：24例小儿食管良性狭窄患者,其中术后吻合口狭窄7例(29.17%),,化学烧伤后狭窄10例(41.67%),贲门失弛缓3例(12.5%),先天性食管狭窄3例(12.5%),腮腺术后损伤所致食管狭窄1例(4.17%)。共行76例次扩张,其中最小年龄100天,最大年龄14岁,中位年龄为10.02岁,4例次因进镜后无法通过交换导丝而未能行扩张,占总例次5.26%,9例次于扩张后行APC烧灼(11.84%),1例于水囊扩张1次,探条扩张4次后放置食管CZES被膜支架,探条扩张59例次(77.63%),,水囊扩张6例次(7.89%),气囊扩张7例次(9.21%),2例次于探条扩张后出现食管穿孔并转外科手术治疗(2.63%),3例次于X线透视下行探条扩张术,扩张前狭窄段距门齿平均20.3±7.38cm,中位距离为18.3cm,扩张前平均狭窄管径0.48±0.21cm,中位管径为0.45cm。探条、水囊、气囊扩张后狭窄处直径均大于扩张前(P0.05),扩张后吞咽困难分级较扩张前相比有统计学意义(P0.05)。术后2例次(2.63%)出现皮下气肿,3例次(3.95%)出现发热,经治疗后均好转。探条组扩张与气囊、水囊组术后吞咽困难分级、狭窄处管径比较无统计学意义(P0.05)。结论：食管术后吻合口狭窄,化学烧伤后狭窄,贲门失弛缓症,先天性狭窄所致的小儿良性狭窄,内镜下扩张为改善吞咽困难症状的有效方法,三组近期扩张效果相比无明显差别。术后食管穿孔为严重并发症,术中观察,及时术后影像学检查有助于发现穿孔。
[Abstract]:Objective: To evaluate the efficacy and difference of endoscopic dilatation for three children with benign esophageal strictures.
Methods: 24 cases of benign esophageal stricture from January 2001 to November 2, 2011 were collected from the First Affiliated Hospital of Guangxi Medical University. The nature, location and degree of esophagus stenosis were analyzed by gastroscopy and upper gastrointestinal barium meal. 24 cases were treated with endoscopic balloon, water sac or sore dilation. Postoperative dysphagia score, narrowing diameter and dilation times under gastroscope were statistically analyzed and compared. The curative effects of three dilation methods were evaluated and followed up.
Results: 24 cases of benign esophageal stricture in children, including 7 cases of postoperative anastomotic stenosis (29.17%), 10 cases (41.67%), 3 cases of Cardia Achalasia (12.5%), 3 cases of congenital esophageal stenosis, 3 cases of congenital esophageal stenosis (12.5%), and 1 cases (4.17%) of esophagus stenosis caused by parotid surgery, among which the minimum age of 100 days, the maximum age of 14, and the middle The age was 10.02 years old, 4 cases failed to expand by exchanging guide wire after entering the mirror, accounting for 5.26%, 9 cases after expansion after APC cauterization (11.84%), 1 cases in the water sac expansion 1 times, the souch expansion 4 times after the placement of the esophageal stent, the expansion of the 59 times (77.63%), the balloon dilatation 6 times (7.89%), balloon dilatation 7 cases (9.21%) After the dilation of the strip, the esophagus perforation and transsurgical operation were found (2.63%), 3 after the X-ray dilatation, the average length of the narrow segment was 20.3 + 7.38cm, the median distance was 18.3cm, the average diameter of the narrow tube was 0.48 + 0.21cm, the median diameter was 0.45cm., the diameter of the water sac and the balloon dilation were all greater than that of the expansion. Before expansion (P0.05), the classification of dysphagia after dilation was statistically significant compared with that before expansion (P0.05). 2 cases (2.63%) had subcutaneous emphysema, 3 cases (3.95%) had fever and improved after treatment. The sore group dilated and balloon, the dysphagia was classified after the operation of the water sac group, and the diameter of the stenosis was not statistically significant (P0.05).
Conclusion: stricture of anastomotic stoma, postoperative stricture of chemical burn, achalasia of cardia, congenital stricture of children caused by congenital stenosis, endoscopic dilatation as an effective method to improve dysphagia symptoms, there is no significant difference between the three groups in the near future. Lookup helps to find perforation.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.7

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