球囊扩张治疗先天性食管闭锁术后食管狭窄的时机选择

目的 探讨新生儿先天性食管闭锁术后吻合口狭窄采用球囊扩张治疗的时机.方法 回顾性分析15例先天性食管闭锁术后吻合口狭窄患儿的临床资料,均在纤维胃镜或电子胃镜下实施球囊扩张术.结果 球囊扩张后直径为0.3～1.2 cm.单个患儿扩张次数为2～6次不等.以呼吸道症状逐渐减轻、消失,饮食由流体状态向固态改善,体重逐渐增加为治疗有效.48次球囊扩张术有43次扩张完成,完成率为89.6%.有效14例,1例扩张术后无好转行胃造瘘术.结论 食管闭锁术后1～3个月是食管狭窄治疗的最佳时机,早期发现并通过球囊扩张治疗新生儿先天性食管闭锁术后食管狭窄是有效而安全的治疗手段.     

胃镜下球囊扩张治疗小儿溃疡性幽门狭窄

目的探讨溃疡性幽门狭窄形成持久性(外科性)幽门梗阻的新的治疗方法。方法对10例幽门口(管)溃疡并狭窄患儿,在静脉复合麻醉下,通过胃镜直视用CRE三级扩张食管球囊行幽门扩张,观察术后腹痛、黑便、呕吐的发生,同时随访术后3、6、9、12个月恢复饮食种类、幽门大小、体重、身高情况。结果总有效率达100%,6～9个月复查胃镜和随访,幽门直径≥12mm,5例可进食普食,4例可进食软饭;8例患儿生长发育赶上同龄儿,占80%。结论CRE三级食管球囊行幽门扩张治疗溃疡性幽门性狭窄,该方法操作简单、效果确切、安全性好。     

胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄的疗效分析

目的探讨胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄的安全性及有效性。方法本研究回顾性收集2017年11月1日至2018年10月31日由首都医科大学附属北京儿童医院收治的61例先天性食管闭锁术后吻合口狭窄病例作为研究对象,其中12例为本院食管闭锁术后患儿。根据患儿辅食添加情况,将首次扩张年龄分为3个月(n=19),3～6个月(n=12),6～12个月(n=9)和≥12个月(n=21)4组。症状缓解持续1个月以上,不需要扩张者被认为短期成功;症状缓解持续3个月以上,不需要扩张者被认为中期成功。结果 61例患儿共扩张331次,单人扩张次数1～13次,扩张次数的中位数和四分位间距为5(IQR:3～7)次。首次扩张年龄3个月的患儿,扩张次数的中位数和四分位间距为4(IQR:3～7)次,扩张终点球囊直径为(8.3±1.2)mm。首次扩张年龄为3～6个月者扩张次数的中位数和四分位间距为5(IQR:3.25～7.0)次,扩张终点球囊直径为(10.1±2.0)mm。首次扩张年龄为6～12个月者扩张次数的中位数和四分位间距为9(IQR:6.5～11.5)次,扩张终点球囊直径为(12.3±2.3)mm。≥12个月的患儿扩张次数的中位数和四分位间距为4(IQR:2～6)次,扩张终点的球囊直径为(13.6±1.7)mm。不同年龄组扩张次数存在统计学差异(H=94.258,P0.001)。不同年龄组扩张终点球囊直径存在统计学差异(F=33.147,P0.001)。61例患儿中,短期扩张成功率为72.1%,中期扩张成功率为59.0%。1例发生穿孔,经保守治疗后痊愈,穿孔率为0.3%(1/331)。结论胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄,疗效满意,并发症少,可作为治疗的第一选择。     

儿童胃镜下食管球囊扩张术后食管穿孔的诊治体会

目的:总结胃镜下食管球囊扩张术后食管穿孔的诊治体会。方法:2017年9月至2019年9月北京儿童医院新生儿外科中心共行胃镜下食管球囊扩张术1 659次,其中4例发生食管穿孔,胃镜下食管球囊扩张术导致食管穿孔的发生率为0.24%(4/1 659)。4例患儿均为男性,食管狭窄的病因分别为2例食管闭锁术后吻合口狭窄,2例食管...     

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

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...     

先天性食管闭锁术后5至9年随访

目的 分析食管吻合术远期并发症,探讨长期随访必要性.方法 对先天性食管闭锁Ⅲ型手术治疗痊愈出院的28例追踪随访5～9年,记录儿保科检查生长发育情况;肺功能、气管CT扫描、气管镜、消化道造影、胃镜.结果 22例生长发育正常范围,6例发育落后,其中反复呼吸道感染4例、气管软化症2例、胃食管反流1例,随访至12个月后发育落后纠正;气管软化症11例,8例治愈,死亡3例.严重软化2例行气管内支架植入,1例成功,1例因气道内肉芽生长行球囊扩张3次.随访至平均(48.4±5.2)个月,存在反复喘息、肺炎7例,5例出现肺功能异常,2例6岁以上患儿存在气道高反应性;7例随访平均(11.4±2.3)个月发生吻合口狭窄,3例为术后吻合口漏患儿.其中5例行球囊扩张术1次,1例扩张2次,1例扩张3次,随访食管造影无复发;9例胃食管反流,临床表现吞咽困难、疼痛、咳嗽、喘息及反复肺炎等,经保守治疗治愈4例,缓解2例,无效3例.平均随访(62.1±7.8)个月,2例轻度反流,1例中度反流,1例重度反流.3例肺功能异常、2例6岁以上患儿气道高反应性.结论 先天性食管闭锁术后存在涉及多学科并发症,长期随访可做到早期发现及进一步治疗.     

球囊扩张术治疗儿童良性食管狭窄

１９９４年１月～１９９６年１２月，笔者应用球囊扩张术治疗儿童各类食管良性狭窄１５例。本文结合病例及治疗中的体会就球囊扩张术治疗儿童良性食管狭窄进行讨论。临床资料：１５例中，男１１例，女４例。年龄１７天～７岁，其中＜２岁９例。因先天性食管闭锁行食管吻合术后吻合口狭窄８例；食管化学烧灼伤致瘢痕狭窄５例，其中１例食管广泛狭窄，１例上、下段食管２处狭窄；胃管代食管术后胃管段狭窄１例；Ｎｉｓｓｅｎ术后食管下端狭窄１例。扩张时年龄最小的仅１７天（食道吻合术后１２天）。除食管闭锁术后狭窄的７例正常进食母乳外，…     

先天性食管闭锁12年疗效评价

目的分析本中心12年来先天性食管闭锁的手术方式及术后近远期并发症,探讨提高食管闭锁治愈率的临床方法。方法对1999年1月至2010年12月作者收治的139例食管闭锁患儿诊治过程、疗效及并发症的防治进行回顾性分析。结果总治愈率84．17％（111／139）,其中I型治愈率为100％（5／5）,111a型治愈率为60．71％（17／28）,IIIb型治愈率为83．81％（88／105）,V型治愈率为100％（1／1）。术后近期吻合口瘘的发生率为19．42％（27／139）。103例随访病例中,远期吻合口狭窄的发生率为24．27％（25／103）,25例接受食管狭窄球囊扩张术,年龄〈6个月者12例,平均扩张2．1次,年龄〉6个月者13例,平均扩张3．6次,21例扩张后症状明显缓解,4例放置食管人工支架辅助持续扩张2～4周后症状缓解。结论提高食管闭锁患儿治愈率需要早期诊断、加强术前术后的管理、改进手术方式以及积极有效地预防和治疗术后并发症。     

胸腔镜在Ⅲ型食管闭锁合并气管食管瘘修补术中的应用研究

目的探讨胸腔镜在Ⅲ型食管闭锁合并气管食管瘘修补术中的应用价值。方法回顾性分析2015年6月至2018年1月采用胸腔镜手术治疗的22例Ⅲ型食管闭锁合并食管气管瘘患儿临床资料,其中男性12例,女性10例;手术年龄2~9 d,平均手术年龄(4.27±1.81)d,体质量1.5~4.05 kg,平均体质量(2.44±0.68)kg。术前均经胸片和上消化道造影明确诊断,均在电视胸腔镜下行食管气管瘘修补及食管吻合术。结果 22例中,除1例中转开胸手术以外,其余病例均在胸腔镜下顺利完成手术;平均手术时间142.3(118~165)min,术后平均住院时间15.41(8~22)d,第一次经口喂养时间平均3.78(3~5)d,平均呼吸机通气时间26.54(9~52)h。术后有8例因吻合口狭窄行胃镜下食管球囊扩张术;2例出现吻合口瘘,1例予延长禁食时间,持续胃肠减压1周后好转,1例家属放弃治疗。除放弃治疗病例外,21例获随访1个月至2年,随访中1例术后1个月出现食管气管瘘经再次手术治愈;5例随访有吻合口狭窄,经1~4次球囊扩张后改善,现无明显吞咽困难;2例有胃食管反流,现保守治疗中;1例气管稍狭窄,现观察中;其余患儿生长发育良好。结论随着新生儿麻醉及手术技术的不断提高,胸腔镜下手术成为Ⅲ型食管闭锁合并气管食管瘘患儿首选的手术方案。     

Re-operation after the primary repair for patients with esophageal atresia

目的 分析总结食管闭锁术后食管再手术的临床经验.方法 2005年6月至2011年7月,8例接受食管闭锁术后食管再手术患儿,男6例,女2例.再手术时年龄6～52个月.7例GrossⅢ型,1例Gross Ⅰ型.再手术前表现为进食后呛咳及进食困难.6例食管气管瘘复发,2例严重狭窄反复扩张无效.8例行食管造影和食管镜检查瘘管及狭窄情况;4例行支气管镜检查.6例术中单肺通气.8例经右胸再手术,切断、缝扎食管气管瘘管,切除狭窄段食管并端端吻合.结果 平均手术时间3～3.5 h.平均住院时间25 d.随访1～72个月,无患儿发生吻合口瘘和食管气管瘘再复发.1例患儿吻合口狭窄扩张1次.结论 食管气管瘘复发多与瘘管未切断及局部炎症有关;食管狭窄与吻合张力高及吻合口漏相关.食管气管瘘复发或/和严重吻合口狭窄是食管再手术的指征.食管镜、支气管镜联合运用,有助于食管气管瘘管复发的诊断和术中定位.单肺通气为再手术提供相对安全的麻醉方式.食管再手术后恢复良好.     

先天性食管闭锁术后食管狭窄的诊治

目的 探讨本院9年先天性食管闭锁(esophageal atresia,EA)术后食管狭窄的诊治,期待提高EA患儿治愈率及生存质量.方法 随访1999年1月至2007年12月本院收治并手术的53例EA病例,总结术后食管狭窄的诊治情况.结果 手术的53例中29例(34.9%)全部经食管造影检查或胃镜直视下确诊为食管狭窄,其中27例(93.1%)扩张后症状缓解.1例(3.5%)放置镍钛合金自膨胀支架2周后治愈.1例(3.5%)出现食管穿孔.结论 球囊扩张是治疗EA术后食管狭窄的有效方法;早期诊断、积极有效地治疗食管狭窄能减少患病率,提高生存质量.     

Anastomotic stenosis after surgical treatment of esophageal atresia: frequency, risk factors and effectiveness of esophageal dilatations]

Anastomotic stricture is the most common complication following the surgical repair of esophageal atresia, and is usually treated by esophageal dilation. OBJECTIVES: The aims of this study were to assess in an infant population operated on at birth for type III or IV esophageal atresia: 1) the frequency of esophageal stenosis following the repair of esophageal atresia, and associated factors; 2) the efficacy of esophageal dilation by the Savary-Gaillard bougie technique. MATERIALS AND METHODS: The medical records of 52 children presenting with esophageal atresia over a 5-year period were retrospectively reviewed. Gestional age and birth weight, duration of mediastinal and transanastomotic drainage, and anastomotic complications including leakage, stricture, and the presence of gastroesophageal reflux were recorded and analysed. Patients presenting with anastomotic stricture were compared with a group of children without stricture. The number of esophageal dilations, their efficacy and the complication rate were analyzed. RESULTS: Anastomotic stricture developed in 20 (40%) of the 50 patients undergoing primary repair for esophageal atresia. The occurrence of anastomotic stricture was related to anastomotic tension during esophageal surgical repair (p < 0.03). Young children required esophageal dilation at a mean age of 142 days (24-930 days). Stricture resolution occurred after a mean of 3.2 dilations (1-15) over an average period of 7.9 months (range: 0-30 months). Dilation was successful in 90% of the 20 patients. Seven patients required only one dilation. Perforation of the esophagus occurred in one case, and this severe complication led to the death of the child. Esophageal dilation was unsuccessful in two patients, who presented prolonged severe dysphagia. CONCLUSION: Anastomotic stricture following repair of esophageal atresia is connected with the length of the gap that has to be repaired, and tension during suture. Esophageal dilation by the Savary-Gaillard bougie technique is an effective method for treating esophageal stricture. Several dilations are usually needed before the disappearance of dysphagia.     

Esophageal surgery in newborns,infants and children

The most common surgery on the esophagus by pediatric surgeons the world over is performed in the newborn period in babies with congenital esophageal atresia with tracheo-esophageal fistula. Post-operative complications like recurrent fistula, anastomotic stricture and some patients with gastroesophageal reflux would also require surgical intervention. Apart from esophageal dilatation, gastrostomy and feeding jejunostomy, children with strictures secondary to caustic ingestion, reflux or previous esophageal anastomosis may require esophageal substitution. This operation may also be required in babies with pure esophageal atresia as well as those with a long gap esophageal atresia with fistula. The entire stomach, stomach tubes, colon or jejunum are often used but techniques preserving as much of the original esophagus as possible are preferable and more physiological. Surgery is also required in children with congenital esophageal stenosis and duplication cyst.     

Successful treatment of severe refractory anastomotic stricture in an infant after esophageal atresia repair by endoscopic balloon dilation combined with systemic administration of dexamethasone

A boy with a history of esophageal atresia repair received an esophagoesophagostomy at 14 months for a severe refractory anastomotic stricture, which had already required repeated balloon dilation with intralesional dexamethasone injection. Anastomotic leakage and stricture was again evident after the second surgery, and the patient underwent five procedures of balloon dilations with intralesional dexamethasone injection. Dysphagia was persistent and the patient required dilation every 2–3 weeks. After the sixth dilation, the patient was given 1 mg/kg per day of dexamethasone i.v. for 3 days. Dexamethasone i.v. was tapered during the following 3 days and finished at day 6. A week later, endoscopic findings showed an apparent improvement in the stricture. Another dilation was followed by 1 mg/kg per day dexamethasone i.v. for 7 days, and 0.75 kg/mg per day oral dexamethasone for another 7 days. The stricture improved completely and the anastomosis was patent after the second dilation. The patient is doing well without dysphagia and has not required additional dilation for over 18 months after the last dilation. Balloon dilation in combination with systemic dexamethasone administration may be an effective treatment that could substitute invasive techniques including surgical manipulation for severe refractory strictures.     

Steroid pulse therapy prevents restenosis following balloon dilatation for esophageal stricture

Purpose

This study aimed to evaluate the effectiveness of intravenous steroid pulse therapy following balloon dilatation for esophageal stenosis and stricture in children.

Methods

The study enrolled six children, including three with congenital esophageal stenosis and three with anastomotic strictures after surgery for esophageal atresia, all of whom were treated by balloon dilatation combined with high-dose intravenous methylprednisolone pulse therapy. Methylprednisolone was injected intravenously at a dose of 20 mg/kg/day for 2 days, starting from the day of dilatation, followed by 10 mg/kg/day for 2 days, for a total of 4 days.

Results

Esophageal stricture recurred in all three patients with congenital esophageal stenosis despite repeated balloon dilatation without methylprednisolone. However, the symptoms of dysphagia improved and did not recur after systemic steroid pulse therapy following balloon dilatation. Symptoms also resolved in all three patients with anastomotic strictures following balloon dilatation with systemic steroid pulse therapy. All six patients remained asymptomatic after 6–21 months follow-up, with no complications.

Conclusion

Intravenous methylprednisolone pulse therapy following balloon dilatation is safe and effective for the treatment of esophageal stenosis and strictures in children.

     

The treatment of post-operative and peptic esophageal strictures after esophageal atresia repair

Nine patients, 6 weeks to 17 years of age with esophageal atresia (EA), developed esophageal strictures and were treated with 26 balloon catheter dilatations over a period of 3 years; 6 are now asymptomatic. Five of the 9 patients had suspected reflux esophagitis, confirmed in 3 by biopsy and treated medically prior to dilatation. Seven of the 9 patients had a primary anastomosis, 1 a gastric tube, and 1 a colonic interposition. Most dilatations in the group of 7 were performed with balloon (B) ≥ the diameter of the distal esophagus (E) (B/E≥1). The 3 residually symptomatic patients include an infant dilated conservatively (B/E<1) to facilitate later bouginage, 1 patient with a recurrent stricture after stopping medical therapy and home bouginage, and 1 infant who had a persistent anastomotic stricture, suspected but untreated reflux esophagitis, and a perforation during the second balloon dilatation. Balloon catheter esophageal dilatation, as an alternative to bouginage, is usually a safe and effective procedure when reflux esophagitis is diagnosed and treated prior to dilatation.     

食管闭锁患儿术后远期并发症及食管功能评价

目的 分析食管吻合术远期并发症及评价食管功能.方法 本研究追踪随访了1990～2007年间27例在新生儿期接受Ⅰ期食管端端吻合术的患儿.观察记录其出院后存在的并发症,包括:生长发育、进食吞咽困难、呼吸系统感染.通过应用食管造影、24h pH监测、24h食管测压手段对食管功能进行分析和评价.结果 平均随访时间(53.1±45.2)个月,48.1%患儿无临床不适表现,48.2%出现远期食管狭窄征象,同时伴有不同程度吞咽困难,22.2%食管狭窄伴严重进食困难者接受食管扩张.22.2%有病理性反流,食管测压结果显示70.3%有食管运动障碍,其中1/3不伴有吞咽困难症状.结论 吻合口狭窄、GER、食管运动障碍、呼吸系统感染等远期并发症基本上不影响患儿的正常生长发育和日常生活,严重的吻合口狭窄行食管扩张术后可以缓解.     

Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia: a systematic review

Surgical repair of oesophageal atresia may result in anastomotic strictures. These strictures are often treated by balloon dilatation (BD) and currently balloon dilatation (fluoroscopic or endoscopic) is the preferred primary treatment method. Here we review the current evidence of the outcomes of balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia. We searched the standard databases (January, 1960–May, 2012) to identify all studies that reported outcomes of balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia in children. Data, reported as median (range), were analysed and compared. Outcomes were success of BD, number of BD sessions, number of oesophageal perforations, need for other surgical interventions and mortality. Five studies were found to be relevant (n?=?139; 81 [58%] male children). The total number of dilatation sessions was 401 (2.9 dilatations per child patient). General anaesthesia was used in two (40%) studies; sedation in a further two (40%) studies and one (20%) study used a combination of both. The size of balloon catheter ranged from 4 mm to 22 mm. Seven perforations were reported (1.8% per dilatation session), of which only one (14%) required surgery. No deaths were recorded. Balloon dilatation for anastomotic strictures post-EA repair is safe, and associated with a low perforation and mortality rates. Most perforations are amenable to conservative management.