管状胃代食管术治疗小儿复杂型食管瘢痕性狭窄的初步研究

目的探讨管状胃代食管手术治疗小儿复杂型食管瘢痕性狭窄的临床价值。方法回顾分析2010年3月至2011年10月广州市妇女儿童医疗中心胸外科应用胸骨后管状胃代食管手术治疗复杂型食管瘢痕性狭窄7例的临床资料。结果7例患儿均为化学性食管灼伤者．长度超过2．5em的食管独段狭窄3例，多段狭窄4例。全组患儿手术过程顺利．术后机械辅助通气时间平均6h，撤机后均无通气不足表现。出现吻合口瘘1例，1周后自愈；吻合1：3瘘并幽门梗阻1例，经术中预留十二指肠管喂养，3周后吻合口瘘自愈，4周后幽门梗阻恢复通畅；出现吻合口狭窄2例，经球囊扩张术后恢复正常饮食。7例患儿平均随访10．5个月．生活质量明显改善．无其他并发症出现．结论管状胃代食管术是治疗复杂型食管瘢痕性狭窄的有效手术．近期疗效好．

Preliminary study on gastric tube esophagoplasty for corrosive strictures of the esophagus in children

Objective To study the clinical value of gastric tube esophagoplasty for complicated corrosive stricture of the esophagus in children. Methods A retrospective analysis was performed to study 7 patients with complicated corrosive stricture of the esophagus who were treated with gastric tube esophagoplasty via retrosternal route between March 2010 and October 2011. Results Three patients had a stricture longer than 2.5 cm, and 4 patients had more than one stricture. All the operations went well. The average time for mechanical ventilation postoperatively was 6 hours. No patients showed insufficient ventilation after withdraw of ventilator. There was 1 patient developed anastomotic leak which was healed a week later. One patient had anastomotic leak with pyloric obstruction, and the leak was healed 3 weeks after intraoperative placement of duodenal feeding tube and pyloric obstruction became patent 4 weeks later. There were 2 patients developed anastomotic stricture and they resumed normal diet after balloon dilatation. The average follow-up duration was 10.5 months. The quality of life was improved and no other complications were found.-Conclusion Gastric tube esophagoplasty is a effective alternative for complicated corrosive stricture of the esophagus and the short-term outcomes are favorable.