儿童食管腐蚀伤的外科治疗

目的　探讨儿童食管腐蚀伤后瘢痕狭窄的预防和治疗措施。　方法　 1988年 5月～ 2 0 0 0年 5月收治食管腐蚀伤儿童 32例 ,早期采用食管扩张 3例 ,食管腔内置管 8例 ;后期采用结肠代食管 14例 ,胃代食管 5例 ,颈阔肌皮瓣修复 2例。　结果　全组手术治愈 31例 ,死亡 1例 ;术后发生并发症 9例 ,其中吻合口瘘 6例 ,吻合口狭窄 2例 ,颈部瘘 1例 ,均治愈。 2 8例随访 1～ 12年 ,均恢复进普通饮食 ;3例失访。　结论　早期食管腔内置管对预防食管腐蚀伤后瘢痕狭窄有明显疗效 ,结肠代食管术是后期食管重建的主要手段 ,主动脉弓以下瘢痕食管可切除用胃重建 ,颈阔肌皮瓣修复术是治疗颈部局限性食管狭窄的理想方法

Surgical Treatment of Caustic Esophageal Injury in Children

Objective To review the methods of prevention and treatment for cicatrical stenosis of esophagus after caustic injury. Methods From May 1988 to May 2000, 32 children suffering from caustic injury of esophagus were admitted to our department. Within one month after injury, 3 were treated with esophageal dilatation, and 8 were treated with intraluminal esophageal stent. In later stage, 21 patients subjected to esophageal replacement including 14 with colon and 5 with stomach, 2 were repaired with platysma myocutaneous flaps. Results In this group, 31 children were cured with operation and only one died. Postoperative complications occurred in 9 cases, including anastomotic leakage in 6, anastomotic stricture in 2 and cervical fistula in 1. All of the 9 cases were cured at last. 28 cases were followed up for 1 to 12 years and 3 were lost of follow up. All of the 28 cases recovered normal diet. Conclusion Intraluminal esophageal stent is an effective method to prevent esophageal stricture after caustic injury in early stage. Colon interposition is the main method for esophageal replacement. It is the better choice for children to remove the cicatrical esophagus and reconstruct with stomach when the stricture is under the aortic arch. The platysma myocutaneous flaps is the ideal technique to repair the cervical esophageal stricture.