结肠代食管术治疗儿童食管严重瘢痕狭窄

目的 探讨儿童食管严重瘢痕狭窄的治疗规律及食管重建术的若干技术要点。方法 回顾分析22例临床资料，男16例，女6例，年龄3～13岁。病因为误服强酸、强碱、农药及烧伤。病程早期均经禁食、激素、抗生素治疗，并作胃或空肠造口及食管扩张术，最后行结肠代食管术。结果 食管改道术20例；病变食管切除，结肠间置术2例。全部治愈。19例随访1～16年，患儿生长、发育、进食与同龄儿童无异。2例并发胸结肠淤滞综合征。结论 结肠代食管术为治疗儿童食管严重瘢痕狭窄的理想方法。取结肠左动脉供血、横结肠顺蠕动向、经前纵隔上提作结肠与下咽或颈食管端端吻合术。术后长期生存质量优良。     

婴幼儿食管瘢痕狭窄的外科治疗

目的：回顾性分析婴幼儿食管良性狭窄30例外科治疗结果。探讨外科治疗各种方法的优劣。方法：30例中男20例，女10例。年龄1岁5个月-5岁，平均29个月。体重5-20kg。除1例为农药烧伤外，余均为误服强酸、碱烧伤。颈段食管完全闭塞3例，基本闭塞5例，余食管造影均见钡剂在食管全长呈不规则线样通过、其中5例伤后曾有时间不等声嘶及吸气性呼吸困难，6例在外院行胃造瘘，全部病例采用保留结肠左动脉升支供血，经胸骨后径路顺蠕动吻合横结肠代食管结肠颈部吻合或结肠咽吻合。结果：手术后颈部吻合口瘘1例，吻合口狭窄1例。术后气管切开1例，经治疗后顺利进食，无手术死亡。经4-20余年随访，患儿发育正常。结论：主张对的食管瘢痕狭窄应积极采取食管重建术。食管替代物中以横结肠为最佳。同期食管瘢痕切除食管的危险性大，手术应以食管旷置为佳。重建平面需在颈部或咽部，不主张任何形式的胸内吻合。     

全胃移植治疗小儿食管瘢痕性狭窄六例

介绍６例全胃移植治疗小儿食管瘢痕性狭窄的手术及经验。６例均为男性，年龄４～９岁。食管烧伤至手术的最短时间１个月，最长１０个月。全组无手术并发症。作者认为：选用全胃作食管床移植胃食管颈部吻合术治疗小儿食管瘢痕性狭窄，可以更直接地恢复消化道的连续性，同时可切除病变食管，防止远期发生粘液性囊肿、癌变及炎性肉芽肿。     

小儿食管瘢痕性狭窄的治疗

小儿误服各种化学腐蚀剂所引起的食管损伤 ,发生食管瘢痕性狭窄者可达5 6 .0 %～ 70 .0 % [1] ,此并发症严重影响患儿的生长发育 ,处理上仍有一定的困难 ,笔者从 1984年 4月～ 1999年 9月共收治 2 9例 ,现报告如下。临床资料本组 2 9例 ,年龄 2～ 14岁。其中 5岁以下 3例 ,5～ 10岁 19例 ,10岁以上 7例。误服强碱溶液 16例 ,误服浓硫酸 8例 ,其他腐蚀剂 3例 (一试灵、敌杀死 ) ,1例记载不详 ,1例食管异物致食管穿孔、瘢痕性狭窄。患儿早期均在外院治疗。来院时均处于食管瘢痕期。其中 3个月内就诊者 6例、3～ 6个月 14例、6个月以上 9例。 2…     

小儿食管化学烧伤瘢痕狭窄的外科治疗

目的　探讨小儿食管化学烧伤瘢痕狭窄的外科治疗经验。方法　本组 42例均采用横结肠代食管、保留结肠左动脉升支、胸骨后顺蠕动吻合 ,其中横结肠咽腔吻合 1 3例 ,横结肠食管颈部吻合 2 9例。结果　手术后颈部吻合口瘘 3例、吻合口狭窄 2例、气管切开 2例 ,经治疗后痊愈 ,无手术死亡。 30例随访 2～ 2 4年 ,患儿发育正常。结论　小儿食管化学烧伤瘢痕狭窄应积极采取胸骨后横结肠代食管 ,同期食管瘢痕切除危险性大 ,以食管旷置为佳 ,重建平面应在颈部或咽部。     

儿童食管瘢痕性狭窄的外科治疗

目的 探讨儿童食管瘢痕性狭窄的外科治疗方法、效果及并发症的预防。方法 分析1991年10月—2001年10月间手术治疗的食管瘢痕性狭窄病人15例，行胃代食管术8例，狭窄段切除、食管端端吻合术1例，结肠代食管术6例。结果 15例均治愈。随访发现结肠代食管者生活质量最好，旷置食管未发生积液性囊肿。胃代食管者术后3例发生重度胃食管反流。结论 经胸骨后结肠代食管术是治疗本病的较好术式，尤其适用于长段狭窄和高位狭窄。胃代食管手术较为简单，但术后可能发生严重胃食管反流。     

确炎舒松A瘢痕内注射联合扩张治疗儿童食管瘢痕狭窄46例

目的探讨儿童食管瘢痕狭窄的治疗方法与疗效。方法我们于近期采用确炎舒松A食管瘢痕内注射联合扩张治疗儿童食管瘢痕狭窄46例,观察其症状变化、狭窄直径、吞咽困难分级及并发症情况。结果 46例中,获及时扩张成功32例,于注射治疗后2~3周再行食管扩张14例。显效24例(占52.2%),有效19例(占41.3%),无效3例(占6.52%),总有效率93.5%。狭窄部位直径由(0.28±0.11)cm增至(0.95±0.34)cm,t=13.81,P0.01,差异有统计学意义。吞咽困难分级由(2.17±0.79)级降至(0.40±0.93)级,P0.01,差异有统计学意义。结论确炎舒松A食管瘢痕内注射联合扩张治疗儿童食管瘢痕狭窄是一种安全可靠的方法。     

小儿食管裂孔疝合并食管狭窄的综合治疗

目的总结小儿食管裂孔疝合并食管狭窄的治疗结果,探讨其综合治疗对策。方法对2005年1月至2014年12月作者收治的2例食管裂孔疝合并食管狭窄患儿进行回顾性总结,采用腹腔镜下食管裂孔疝修补术±Nissen-Rossettil胃底折叠抗反流术,术后在DSA透视下进行食管球囊导管扩张治疗,并应用抑酸药物减少食管反流。结果 2例均为男性,初诊年龄分别为6个月和17个月,术前上消化道造影检查提示食管裂孔疝合并食管狭窄,术中置食管支撑管均失败,仅能通过6F胃管。术后给予口服药物控制反流,保护食管黏膜,并分别行食管球囊导管扩张治疗8次和2次,从6~#球囊导管扩张至10~#~12~#球囊导管,扩张后均能进食半流质,吞咽功能良好,无反流症状。结论小儿食管裂孔疝合并食管狭窄通过腹腔镜食管裂孔疝修补术±胃底折叠抗反流术、食管球囊导管扩张和药物治疗可达到满意的疗效。     

小儿食管化学烧伤性狭窄的外科处理

因误吞强碱、强酸等导致食管化学烧伤性狭窄患儿１８例。年龄１－８岁，病程平均５个月。累及食管上段者６例，中下段者１２例。全部患儿均施行胃造瘘术支持治疗，择期行食管扩张术１２例，各种术式修复６例。１８例中１０例获得随访。本组经验表明：伤后早期激素和抗生素治疗可防严重瘢痕狭窄的形成；年龄小、部位高、狭窄段短者尽早施行食管扩张有效；晚期有不开胸、顺蠕动、颈段食管与回肠腔径相近易于吻合无吻合口瘘之虑等优点，     

儿童食管狭窄的病因及诊治进展

食管狭窄相关疾病包括:先天性食管狭窄、食管闭锁术后狭窄、胃食管反流伴发狭窄、食管化学烧灼伤引发狭窄、嗜酸性食管炎、放化疗后食管狭窄等。目前我国难治性食管狭窄多为食管化学烧灼伤后狭窄。食管连续扩张是治疗此类疾病的首选方法,疗效不佳时可配合使用激素、丝裂霉素等药物。食管替代术是该类疾病的最后防线。食管狭窄相关疾病诊治水平还需要多中心联合才能不断提高。     

Surgical treatment of dysrhythmias in infants and children

The recognition of medically refractory dysrhythmias in children has necessitated the use of more invasive nonpharmacologic therapies. The role of ablative surgery in the management of pediatric rhythm disturbances is presented.     

婴幼儿先天性脊柱侧后凸畸形的手术治疗

目的总结婴幼儿先天性脊柱侧后凸畸形的手术治疗经验。方法回顾性分析1999年10月~2006年12月经手术治疗的20例先天性脊柱侧后凸畸形病例资料。其中男8例,女12例。年龄11个月~3岁8个月。根据Winter及MCmaster分型,前方和单侧形成不全(后外侧1/4椎体)9例,前方形成不全(后方半椎体)7例,凸侧半椎体凹侧骨桥4例。脊柱侧凸Cobb角30°~50°,后凸Cobb角36°~56°。手术方法:4例行单纯脊柱后路短段融合术;6例经脊柱后路凸侧椎弓根行半椎体半骺切除 融合术;2例行侧前路椎体骺板及半锥体切除术;8例行脊柱后路短段融合 钢丝襻及钩棒系统矫形固定术。结果全部病例术后脊柱侧凸及后凸畸形部分矫正或原位融合,无并发症。经1~7年随访,5例脊柱侧后凸减轻;8例脊柱侧后凸无明显变化;2例脊柱畸形加重半椎体复出;3例假关节形成;2例钩棒脱出,无钢丝断裂。结论婴幼儿脊柱柔韧,可塑性强,在畸形尚未加重之前可通过脊柱后路手术矫正并控制脊柱畸形的进展,用钢丝襻固定可及时矫正畸形,稳定脊柱。近期疗效满意,远期疗效有待继续随访。     

Laparoscopically assisted transhiatal esophagectomy with esophagogastroplasty for post-corrosive esophageal stricture treatment in children

A tight post-corrosive esophageal stricture in a child poses significant surgical challenges. Many studies have described minimally invasive esophagectomy in adults, but very few reports have described this technique in children. Minimally invasive esophagectomy represents a new alternative to conventional open esophagectomy. This retrospective study evaluated the safety and efficacy of laparoscopically assisted transhiatal esophagectomy and gastric transposition for post-corrosive esophageal stricture treatment. Twenty-seven children with post-corrosive esophageal stricture were subjected to this technique. Their ages ranged from 3 to 13.5 years (mean 5.6 years). Fourteen were females and thirteen were males. None of the procedures needed to be converted to an open approach, and there were neither intra-operative complications nor increased blood loss. Left-sided pneumothorax occurred in one case only (3.7%). The mean operating time was 160 min (range 120–180). Three patients were admitted postoperatively to intensive care unit for a period of 48 h for assisted ventilation. Mean hospital stay was 4 days (range 3–7 days). Anastomotic leakage occurred in three patients (11.1%), while anastomotic stricture occurred in four patients (14.8%). About 93.5% of our cases have achieved excellent results. Post-operative nutritional status was satisfactory and accepted. Laparoscopically assisted transhiatal esophagectomy and gastric transposition for post-corrosive esophageal stricture treatment in children is safe, visible, effective, and an accepted operative technique. The cosmetic result is excellent.     

胃镜直视下球囊扩张术治疗小儿食管狭窄

目的 探讨胃镜直视下球囊扩张治疗小儿食管狭窄的安全性和有效性.方法 12例食管狭窄患儿,其中食管闭锁术后吻合口狭窄7例、先天性食管狭窄3例、腐蚀性炎性狭窄2例,年龄5～59个月,在静脉复合麻醉和气管插管下,通过胃镜直视用控制辐射状扩张(CRE)三级扩张球囊行食管狭窄扩张.观察术后腹痛、黑便、呕吐的发生,同时随访术后3～12个月恢复饮食种类,狭窄口大小、营养情况.结果 12例共进行22次扩张,19次成功,3次术后出现并发症,扩张成功率为86%.12例中,3例扩张失败,9例扩张成功、症状改善,有效率为75%.扩张前狭窄口直径2～8 nun,3～12个月后复查胃镜和随访,狭窄口直径9～13mm,8例可进食固体食物、营养状况改善.结论 CRE三级食管球囊行食管狭窄扩张治疗,操作简单、效果确切,食道闭锁术后吻合口狭窄的扩张效果较好.     

儿童复杂性尿道狭窄的治疗

目的 探讨儿童复杂性尿道狭窄手术方法的选择及成功的关键。方法 25例复杂性尿道狭窄采用不同的手术方法治疗30次，其中采用口腔粘膜管状重建尿道3例。口腔粘膜补片尿道成形3例；经耻骨径路尿道端端吻合11例，膀胱壁瓣尿道成形2例；经会阴径路尿道端端吻合8例；双阴唇带蒂皮瓣Ⅰ期尿道成形2例；带蒂包皮内板Ⅰ期尿道成形1例。结果 术后随访2-36个月。平均18.5个月。一次手术后排尿通畅20例。术后效果不佳5例。经再次手术后排尿通畅4例。结论 儿童尿道狭窄手术方法的选择应根据尿道狭窄段的长短，位置选择合适的术式；口腔粘膜具有取材方便。创伤小，有较强的抗感染力的优点，是一种较好的尿道替代物。     

Persistence of corrosive esophageal stricture due to gastroesophageal reflux in children

Four children with severe corrosive esophageal strictures persisting despite repeated dilatations are presented. These resistant stenoses are believed to be secondary to gastroesophageal reflux, which causes peptic esophagitis, perpetuating the esophageal stricture. Attempts at conservative management were not successful. In all four patients an anti-reflux procedure (Nissen) resulted in cure of the stenosis. Offprint requests to: M. Capella     

Surgical techniques for esophageal replacement in children

Purpose

Surgical techniques for esophageal replacement (ER) in children include colon interposition, gastric tube, gastric transposition, and jejunal interposition. This review evaluates the merits and demerits of each.

Method

Surgical techniques, complications, and outcome of ER are reviewed over last seven decades.

Results

Colon interposition is the time-tested procedure with minimal and less serious complications. Long-term complications include reflux, halitosis, colonic segment dilatation, and anastomotic stricture, sometimes requiring surgical interventions especially for dilatation and reflux. Gastric tube is technically more risky, and associated with early serious complications like prolonged leak in neck or mediastinum, graft necrosis, and ischemia leading to stricture of the tube. Long-term results are good. Gastric transposition is much simpler, can be performed in emergency and in newborns. It involves a single anastomosis in the neck. Post-operative complications include gastric stasis, bile reflux, restricted growth, and decreased pulmonary functional capacity. Jejunal interposition has not been used extensively due to short mesentery but long-term results are good in expert hands.

Conclusion

Colon is the most preferred and safest organ for ER. Stomach is a vascular and muscular organ with lower risk of ischemia. Gastric tube is a demanding technique. Jejunum or ileum is alternative for redo cases.

     

Endoscopic sclerotherapy of esophageal varices in infants and children

Thirty children, aged 7 months to 13 years, with bleeding esophageal varices were managed by endoscopic sclerotherapy (EST). Of these children, 73.3% had extrahepatic portal vein obstruction (EHPVO), 16.6% had cirrhosis of the liver, and 10% had noncirrhotic portal fibrosis. EST was done with fiberoptic pediatric upper gastrointestinal endoscopes and a flexible sclerotherapy needle under sedation with intravenous diazepam and pentazocine. The sclerosants used were ethoxysclerol 1% and absolute alcohol. Ten injections were given to control active variceal bleeding, and 145 injections were given on planned basis at 2-3-week interval. An average of five injections was required to obliterate the esophageal varices. In 90% of cases, an avariceal state was achieved; 10% had decreased size and number of varices. Emergency EST was effective to control bleeding in all sessions. Complications, including retrosternal discomfort, esophageal ulceration, stricture formation, and aspiration pneumonia, occurred in 60, 20, 20, and 6.6% of cases, respectively; complications were managed conservatively. Strictures were dilated with Eder-Puestow's olive dilators. Recurrence of esophageal varices, gastric varices, and rebleeding was seen in 13.3, 13.3, and 10% of cases, respectively. Shunt surgery was performed in 13.3% cases, who had developed gastric varices and were having EHPVO.