目的 探讨内镜下食管扩张术在儿童腐蚀性食管狭窄治疗中的临床应用。 方法 回顾性收集在浙江大学医学院附属儿童医院进行内镜下食管扩张治疗的15例腐蚀性食管狭窄患儿的临床资料，分析其临床特征、内镜下食管扩张治疗方式、扩张次数、并发症及预后等情况。 结果 15例患儿共进行96例次内镜下食管扩张治疗，每位患儿中位扩张次数为6次，其中扩张次数≥6次者9例（60%）。食管狭窄长度>3 cm患儿食管扩张治疗次数明显多于狭窄长度≤3 cm患儿（P<0.05）。单一狭窄段患儿治疗疗效优于多个狭窄段患儿（P=0.005）。所有扩张治疗过程中无一例发生并发症。内镜下食管扩张治疗总有效率（显效及有效）为87%，2例失败。 结论 内镜下食管扩张是治疗儿童腐蚀性食管狭窄的有效方法，且相对安全；单一狭窄段患儿食管扩张治疗疗效优于多段狭窄段患儿。］
Abstract
Objective To investigate the clinical application of endoscopic esophageal dilation in the treatment of corrosive esophageal strictures in children. Methods A retrospective analysis was performed on the clinical data of 15 children with corrosive esophageal strictures who underwent endoscopic esophageal dilation in Children's Hospital, Zhejiang University School of Medicine. The clinical features, treatment modality of endoscopic esophageal dilation, number of dilations, complications, and prognosis were reviewed. Results A total of 96 esophageal dilations were performed in the 15 children with corrosive esophageal strictures, with a median of 6 dilations per child. Among them, 9 children (60%) underwent 6 or more dilations. The children with a stricture length of >3 cm had a significantly higher number of dilations than those with a stricture length of ≤3 cm (P<0.05). The children with strictures in a single segment had a significantly better treatment outcome than those with strictures in multiple segments (P=0.005). No complication was observed during all sessions of dilation. The overall effective rate (including significant improvement and improvement) of endoscopic esophageal dilation treatment was 87%, with 2 cases of failure. Conclusions Endoscopic esophageal dilation is an effective and relatively safe treatment method for corrosive esophageal strictures in children, and children with strictures in a single segment tend to have a better treatment outcome than those with strictures in multiple segments.
关键词
腐蚀性食管狭窄 /
内镜下食管扩张 /
儿童
Key words
Corrosive esophageal stricture /
Endoscopic esophageal dilation /
Child
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参考文献
1 Youn BJ, Kim WS, Cheon JE, et al. Balloon dilatation for corrosive esophageal strictures in children: radiologic and clinical outcomes[J]. Korean J Radiol, 2010, 11(2): 203-210. PMID: 20191068. PMCID: PMC2827784. DOI: 10.3348/kjr.2010.11.2.203.
2 El-Asmar KM, Allam AM. Predictors of successful endoscopic management of caustic esophageal strictures in children: when to stop the dilatations?[J]. J Pediatr Surg, 2021, 56(9): 1596-1599. PMID: 32943196. DOI: 10.1016/j.jpedsurg.2020.08.017.
3 谢惠, 李娜, 康倩, 等. 内镜下治疗儿童腐蚀性食管狭窄25例分析[J]. 人民军医, 2020, 63(7): 701-703.
4 Uygun I, Arslan MS, Aydogdu B, et al. Fluoroscopic balloon dilatation for caustic esophageal stricture in children: an 8-year experience[J]. J Pediatr Surg, 2013, 48(11): 2230-2234. PMID: 24210191. DOI: 10.1016/j.jpedsurg.2013.04.005.
5 中华医学会儿科学分会消化学组, 中华儿科杂志编辑委员会. 中国儿童食管狭窄诊治专家共识[J]. 中华儿科杂志, 2023, 61(7): 588-593. PMID: 37385800. DOI: 10.3760/cma.j.cn112140-20230417-00277.
6 Barrón Balderas A, Robledo Aceves M, Coello Ramírez P, et al. Endoscopic findings of the digestive tract secondary to caustic ingestion in children seen at the emergency department[J]. Arch Argent Pediatr, 2018, 116(6): 409-414. PMID: 30457719. DOI: 10.5546/aap.2018.eng.409.
7 Kurowski JA, Kay M. Caustic ingestions and foreign bodies ingestions in pediatric patients[J]. Pediatr Clin North Am, 2017, 64(3): 507-524. PMID: 28502435. DOI: 10.1016/j.pcl.2017.01.004.
8 Di Nardo G, Betalli P, Illiceto MT, et al. Caustic ingestion in children: 1 year experience in 3 Italian referral centers[J]. J Pediatr Gastroenterol Nutr, 2020, 71(1): 19-22. PMID: 32142003. DOI: 10.1097/MPG.0000000000002685.
9 Chen CC, Chen AC, Wu SF. Alkaline substances gastroesophageal injury in young children: emphasis on Asian food preparation habits[J]. J Formos Med Assoc, 2021, 120(10): 1907-1913. PMID: 33422399. DOI: 10.1016/j.jfma.2020.12.027.
10 Arnold M, Numanoglu A. Caustic ingestion in children: a review[J]. Semin Pediatr Surg, 2017, 26(2): 95-104. PMID: 28550877. DOI: 10.1053/j.sempedsurg.2017.02.002.
11 Raboei E, Alabdali A, Sayed MH, et al. The outcome of pediatric esophageal strictures managed with endoscopic balloon dilation in Saudi Arabia[J]. J Laparoendosc Adv Surg Tech A, 2021, 31(2): 210-215. PMID: 33216676. DOI: 10.1089/lap.2020.0455.
12 Ahmadi M, Manzari-Tavakoli M, Javaherizadeh H, et al. Efficacy of endoscopic balloon dilation in Iranian pediatric patients with esophageal stricture[J]. Arq Gastroenterol, 2021, 58(4): 520-524. PMID: 34909860. DOI: 10.1590/S0004-2803.202100000-93.
13 Josino IR, Madruga-Neto AC, Ribeiro IB, et al. Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: systematic review and meta-analysis[J]. Gastroenterol Res Pract, 2018, 2018: 5874870. PMID: 30116265. PMCID: PMC6079446. DOI: 10.1155/2018/5874870.
14 El-Asmar KM, Youssef AA, Abdel-Latif M. The effectiveness of combined balloon and bougie dilatation technique in children with impassable esophageal stricture[J]. J Laparoendosc Adv Surg Tech A, 2021, 31(6): 724-728. PMID: 33650883. DOI: 10.1089/lap.2020.0926.
15 Fugazza A, Repici A. Endoscopic management of refractory benign esophageal strictures[J]. Dysphagia, 2021, 36(3): 504-516. PMID: 33710389. DOI: 10.1007/s00455-021-10270-y.
16 Cakmak M, Boybeyi O, Gollu G, et al. Endoscopic balloon dilatation of benign esophageal strictures in childhood: a 15-year experience[J]. Dis Esophagus, 2016, 29(2): 179-184. PMID: 25515612. DOI: 10.1111/dote.12305.
17 Aragón S, Valero J, Padilla L, et al. Predictors of clinical response of esophageal dilatations in pediatric population[J]. J Pediatr Surg, 2022, 57(6): 1127-1131. PMID: 35184881. DOI: 10.1016/j.jpedsurg.2022.01.037.
18 Karaman ?, Ko? O, Karaman A, et al. Evaluation of 968 children with corrosive substance ingestion[J]. Indian J Crit Care Med, 2015, 19(12): 714-718. PMID: 26813230. PMCID: PMC4711203. DOI: 10.4103/0972-5229.171377.
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