Colon interposition for esophagus in children

In 25 years, from 1959 to 1984, esophageal substitution was performed in 32 patients. In most, the transverse colon was used, brought through the left chest on a vascular pedicle of the left colic artery. Indications for operation included: 21, esophageal atresia; 5, caustic injury; 3, peptic stricture; 2, esophageal varices with previous splenectomy; and 1, cartilagenous hamartoma of the esophagus. Six patients had failed prior reconstructions (1, gastric tube; 2, intrathoracic stomach; 1, presternal jejunum; 1, sloughed colon segment, 1, extensive stricture after primary repair). There was one postoperative death from fluid overload early in the series. Two patients had a localized leak at the upper anastomosis in the neck; neither resulted in stricture. One patient had a side leak in the lower intrathoracic colon, probably from an anchoring suture placed too deeply. Most patients had pyloroplasty with their operation. Four who did not required one later. Four patients required late reoperation for redundancy of the lower colon segment which emptied poorly; one lower colon was revised for stricture from exstrinsic compression at the substernal hiatus and another one for an inflammatory pseudopolyp with bleeding. There was no loss of a colon segment from ischemia. There is follow-up on all but one patient. Nineteen are more than ten years postoperative (mean of 18 years). Growth was assessed in that group. In atresia patients growth correlated with weight preoperatively and the presence or absence of associated anomalies. In the others growth was excellent in all but one patient. In our experience the colon conduit provides an excellent substitute esophagus for pediatric patients. The operation should have relatively low rate of major complications, most of which are avoidable, and most of which can be corrected to give a satisfactory long-term result.     

Minimally invasive esophagectomy for caustic esophageal stricture in children

Esophageal stricture after lye ingestion in children is the most frequent indication for esophagectomy in children, but this operation entails significant risks for complications. With continuing advances in minimally invasive technology, complex procedures such as esophagectomy can be performed using small incisions, with the aim of reducing morbidity and mortality. Experience with minimally invasive esophagectomy is limited and has involved thoracoscopic dissection with the addition of laparotomy for gastric mobilization. The authors report a case of intractable caustic esophageal stricture in a child treated by a totally minimally invasive esophagectomy through a combined thoracoscopic and laparoscopic approach. In adult patients, this procedure has been associated with decreased hospital stay and more rapid return to normal activities, and we believe similar benefits will be obtained in children. Until further studies are done to show the advantage over the standard open technique, this procedure should be performed only in centers with experience in open esophageal surgery in children as well as by surgeons with advanced thoracoscopic and laparoscopic skills.     

颈部食管憩室误诊甲状腺癌五例分析及文献复习

目的探讨颈段食管憩摩的临床特点、诊断和治疗方法,避免误诊甲状腺癌。方法 回顾性分性分析颈段食管憩窜误诊为甲状腺癌的临床资料,5例患者均术前误诊为甲状腺癌,其中Zenker憩审4例,Killian-Jamieson憩窜1例,患者均系查体发现,术前九临床症状。结果5例患者中行手术EU除3例,观察1例,内翻缝合1例,无并发症发生,随访6个月到4年无复发。结论Zenker憩室和Killian-Jamieson憩室具有不同的临床特征,甲状腺外科跃师应该熟知,避免误诊和误治。     

Trimetazidine reduces the degree of fibrosis in alkali burns of the esophagus

Purpose

The aim of this study was to investigate the efficacy of trimetazidine (TMZ), an antioxidant agent, on the prevention of stricture development after esophageal caustic injuries in rat.

Methods

Thirty rats were divided into 3 equal groups. A standard esophageal caustic burn was produced by application of 37.5% NaOH for a period of 90 seconds followed by water rinse. Group A (sham) animals were uninjured. Group B rats were injured but untreated. Group C rats were injured and received TMZ (5 mg/kg/d) via intraperitoneal route. Efficacy of the treatment was assessed in 28 days by measuring stenosis index and histopathologic damage score and by determining tissue hydroxyproline content.

Results

The stenosis index in the TMZ-treated group was significantly lower than the untreated group, similarly in the sham laparotomy group (stenosis index: 0.34 ± 0.10, 0.94 ± 0.21, 0.38 ± 0.05, respectively; P < .05). The hydroxyproline level (microgram per milligram of wet tissue) was significantly lower in the TMZ-treated group compared with untreated group, similarly in the sham laparotomy group (1.06 ± 0.14, 1.33 ± 0.08, 0.68 ± 0.15 μg/mg wet tissue, respectively; P < .05). In the untreated group, histopathologic damage score was significantly higher than TMZ-treated group (P < .05).

Conclusions

Trimetazidine reduces the degree of fibrosis and ameliorates histopathologic damage in experimental model of corrosive esophagitis in rats.     

Bouginage in chemical burns of the esophagus in children]

851 children suspected to have chemical burn of the esophagus were treated from 1996 to 2000. Use of esophageal bouginage along the guiding string has changed medical policy for esophageal burns. We completely rejected early bouginage. Late bouginage was necessary for 22% patients with II-III degree of chemical burns (3.8% of all hospitalized children). Results of the new policy depended on chemical agent. The best results were achieved after acetic acid burns. It is difficult to treat alkali burns leading to prolonged esophageal stenosis, and manganese crystal burns leading to pharynx injuries.     

Caustic esophageal strictures in children: 30 years' experience

Many children in developing countries continue to sustain caustic esophageal injures. The first line of treatment is dilatation, unless contraindicated, where 60% to 80% success rate is expected. In cases of failure, esophageal replacement is the only hope for achieving normal swallowing. Over the last 30 years, more than 850 cases of esophageal replacement were done in the Pediatric Surgery Department at Ain-Shams University. Three types of replacement were performed, gastric pull-up (75 cases), retrosternal colon replacement (550 cases), and, in the last 12 years, transhiatal esophagectomy with posterior mediastinal colon replacement (225 cases). Complications in the last 475 cases include 10% cervical leakage, 5% proximal strictures, 2% postoperative intestinal obstruction, 1% mortality, and 0.6% late graft stenosis. Colonic replacement of the esophagus is the ideal treatment in cases of caustic esophageal strictures after failure of dilatation. The posterior mediastinal route is shorter, and in long-term follow-up results show improved evacuation and less reflux than with the retrosternal route.     

The treatment of chemical burns of the esophagus in children

The article covers the 22-year experience of treatment of chemical burns of the esophagus in 4252 children. The cicatrical stricture (the III degree burn) of the esophagus had 5.9% of patients. 82% of all patients were aged 1-3 years. The endoscopic signs of esophageal burns, developed in clinic, allow the thorough differentiation of burn stages, which has certain influence on treatment strategy. Treatment strategies, depending on the stage of esophageal burn and chemical agent, were described. Methods and terms of gullet bougienage were analyzed.     

脊髓型颈椎病前路手术后并发食管憩室瘘1例

1 病例资料 患者,男,38岁.因四肢麻木2年,加重伴双下肢行走不稳1年,于2006年3月8日入院.专科检查:双手、双足痛温觉减退,双手握力3级,肱二、肱三头肌力3级,双下肢肌力4级,双侧Hoffmann征( ),四肢腱反射亢进,Babinski征(-),颈椎MRI示C5～6椎间盘突出伴脊髓受压.诊断为脊髓型颈椎病.3月12日,在颈丛 局麻下前路行C5～6椎间盘切除,自体髂骨植骨钛板内固定术,术后予抗炎、止血、对症治疗.     

Anatomic mapping and evaluation of the esophagus in relation to the cervical vertebral body

The relationship of the esophagus to the cervical vertebral body (CVB), disc space and longus colli (LC) muscles, to our knowledge, has not been previously studied. The purpose of this study was to quantify the relationship of the esophagus to the CVB, disc space and LC. 30 patients were selected for a retrospective review of computed tomography (CT) scans. Measurements between the esophagus and the C5, C6, and C7 vertebral bodies as well as the C5/6 and C6/7 disc spaces were performed in the midline, 3 mm right and left of midline, and at the edge of the LC on both sides. The closest distance of the esophagus to the CVB and disc space occurs at the midline (range 1.02–1.31 mm at each level). The furthest distance occurred at the edge of the right LC (range 2.67–3.30 mm at each level). The mean distance from the edge of the right LC to the midline was significantly greater (P < 0.01) than mean distance from the edge of the left LC to the midline. No statistical significant differences were observed when comparing measurements at the individual vertebral bodies and disc spaces. The results of the study demonstrate that the esophagus lies in closest proximity to the CVB and disc space in the midline. A larger potential space exists between the esophagus and the CVB and disc space at the edge of the LC. These results may provide insight into a potential cause of post-operative dysphagia. Furthermore, it may help guide the future design of cervical plates to better utilize the potential space between the esophagus and the CVB and disc space at the edge of the LC.