Duan Jiaqi,You Jieyu,Luo Yanhong,et al.Clinical characteristics and endoscopic treatment of benign esophageal stricture in children[J].Journal of Clinical Pediatric Surgery,2025,(07):662-667.[doi:10.3760/cma.j.cn101785-202502030-012]
儿童良性食管狭窄临床特征及内镜治疗
- Title:
- Clinical characteristics and endoscopic treatment of benign esophageal stricture in children
- 摘要:
- 目的 探索儿童良性食管狭窄的临床特征及精细化内镜治疗方式选择。方法 回顾性分析2015年1月至2023年7月湖南省儿童医院消化营养科收治并行内镜治疗的64例食管狭窄患儿临床资料,按照病因分为先天性食管狭窄组(11例)、反流性食管狭窄组(16例)、外科术后食管狭窄组(16例)、腐蚀性食管狭窄组(10例)、贲门失弛缓组(11例),分析发病特征、治疗方式选择、疗效评估及并发症情况。结果 5组不同病因食管狭窄患儿的初诊年龄、性别、狭窄长度类型差异均有统计学意义(P<0.05);贲门失弛缓患儿初诊年龄[9.1(7.0,12.7)岁]明显大于其他组,而外科术后食管狭窄组初诊年龄最小[0.5(0.2,2.0)岁]。腐蚀性食管狭窄以长段型多见,而其他病因所致食管狭窄以短段型多见。贲门失弛缓组11例中,5例(45.4%)早期行球囊扩张治疗,其中1例经2次扩张后症状缓解3年,余4例经1次扩张后症状缓解不明显,最终均选择经口内镜下食管括约肌切开术(peroral endoscopic myotomy,POEM),术后均正常进食,随访至今无任何并发症发生。5组食管狭窄的症状持续时间(首次内镜治疗距离症状出现的时间)差异有统计学意义(P＜0.05),其中腐蚀性食管狭窄时间最短[1.3(0.7,2.1)个月]。5组穿孔率比较,差异有统计学意义(P＜0.05);腐蚀性食管狭窄组发生穿孔5例,其中4例穿孔分别发生于腐蚀伤发生后第23天、第60天、第75天、第90天的球囊扩张治疗中,1例为腐蚀伤发生后第123天出现自发穿孔,均予禁食、胃肠减压、胸腔闭式引流、抗感染等保守治疗后瘘口自愈。1例先天性食管闭锁术后食管狭窄合并重度喉气管软化的患儿,行球囊扩张术后气道压高、拔管困难转重症监护室呼吸支持治疗,2天后顺利拔管。64例均未发生术后出血。结论 内镜微创技术是治疗儿童良性食管狭窄安全、有效的选择,球囊扩张是食管狭窄的首选治疗方案,病程中联合药物治疗、切开治疗、支架置入等制定个体化方案有助于提高疗效;治疗过程中并发症的发生需引起高度重视并及时处理,可获得良好效果。
- Abstract:
- Objective To explore the clinical characteristics of benign esophageal strictures in children and to explore refined strategies for endoscopic treatment. Methods A retrospective analysis was conducted on 64 pediatric patients with esophageal strictures who received endoscopic treatment at the Department of Digestive Nutrition,Hunan Children’s Hospital,between January 2015 and July 2023.Patients were classified by etiology into five groups:congenital esophageal stricture (11 cases),reflux-related stricture (16 cases),postoperative stricture (16 cases),corrosive stricture (10 cases),and achalasia (11 cases).Clinical characteristics,treatment strategies,efficacy evaluation,and complications were analyzed. Results Significant differences were found in initial age at diagnosis,gender,and stricture length/type among the 5 groups (P<0.05).The achalasia group had the oldest median age at diagnosis[9.1(7.0,12.7) years],while the postoperative group had the youngest[0.5(0.2,2.0) years].Long-segment strictures were more common in corrosive cases,while short-segment strictures predominated in other etiologies.In the achalasia group,5 out of 11 patients(45.4%) initially underwent balloon dilation; one achieved 3-yearsymptom relief after two dilations,but the other four showed minimal response and ultimately underwent peroral endoscopic myotomy (POEM),all with successful outcomes and no complications during follow-up.Theduration of symptoms (interval from onset to first endoscopic treatment) differed significantly among groups (P<0.05),with corrosive strictures having the shortest duration[1.3(0.7,2.1) months].Perforation rates also differed significantly (P<0.05); fiveperforations occurred in the corrosive group-four during balloon dilation performed 23,60,75,and 90 days post-injury,and one spontaneous perforation on day 123.All were managed conservatively with fasting,thoracic drainage,and antibiotics,leading to spontaneous fistula closure.One patient with postoperative congenital esophageal atresia and severe laryngotracheomalacia developed airway pressure issues after balloon dilation,requiring ICU respiratory support and was successfully extubated 2 days later.No postoperative bleeding was observed in any case. Conclusions Endoscopic minimally invasive treatment is a safe and effective option for benign esophageal strictures in children.Balloon dilation remains the first-line treatment for most etiologies,and combining it with medication,incision therapy,or stenting in a personalized plan can enhance outcomes.Attention to potential complications and timely management ensures favorable results.
参考文献/References:
[1] 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.DOI:10.3760/cma.j.cn112140-20230417-00277. The Subspecialty Group of Gastroenterology,the Society of Pediatrics,Chinese Medical Association,the Editorial Board,Chinese Journal of Pediatrics.Expert consensus on diagnosis and treatment of esophageal stricture in Chinese children[J].Chin J Pediatr,2023,61(7):588-593.DOI:10.3760/cma.j.cn112140-20230417-00277.
[2] Ogilvie AL,Dronfield MW,Ferguson R,et al.Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy[J].Gut,1982,23(12):1060-1067.DOI:10.1136/gut.23.12.1060.
[3] Ghiselli A,Bizzarri B,Ferrari D,et al.Endoscopic dilation in pediatric esophageal strictures:a literature review[J].Acta Biomed,2018,89(8-S):27-32.DOI:10.23750/abm.v89i8-S.7862.
[4] Fak?oglu E,Güney LH,?tgün?.Esophageal dilation through bou-ginage or balloon catheters in children,as the treatment of benign esophageal strictures:results,considering the etiology,and the methods[J].Ulus Travma Acil Cerrahi Derg,2023,29(5):574-581.DOI:10.14744/tjtes.2022.03881.
[5] K?l?? ?S,Serdar ?skit H.Management and clinical outcomes of congenital esophageal stenosis in pediatric patients:experience of a tertiary referral center[J].J Pediatr Surg,2022,57(3):518-525.DOI:10.1016/j.jpedsurg.2021.06.006.
[6] Qi L,He W,Yang J,et al.Endoscopic balloon dilation and submucosal injection of triamcinolone acetonide in the treatment of esophageal stricture:a single-center retrospective study[J].Exp Ther Med,2018,16(6):5248-5252.DOI:10.3892/etm.2018.6858.
[7] Yasuda JL,Staffa SJ,Clark SJ,et al.Endoscopic incisional therapy and other novel strategies for effective treatment of congenital esophageal stenosis[J].J Pediatr Surg,2020,55(11):2342-2347.DOI:10.1016/j.jpedsurg.2020.01.013.
[8] Baghdadi O,Yasuda J,Staffa S,et al.Predictors and outcomes of fully covered stent treatment for anastomotic esophageal strictures in esophageal atresia[J].J Pediatr Gastroenterol Nutr,2022,74(2):221-226.DOI:10.1097/MPG.0000000000003330.
[9] Terui K,Saito T,Mitsunaga T,et al.Endoscopic management for congenital esophageal stenosis:a systematic review[J].World J Gastrointest Endosc,2015,7(3):183-191.DOI:10.4253/wjge.v7.i3.183.
[10] 张宾宾,董岿然.先天性食管狭窄的治疗进展[J].中华小儿外科杂志,2018,39(4):308-311.DOI:10.3760/cma.j.issn.0253-3006.2018.04.015. Zhang BB,Dong KR.Advances in the treatment of congenital esophageal stenosis[J].Chin J Pediatr Surg,2018,39(4):308-311.DOI:10.3760/cma.j.issn.0253-3006.2018.04.015.
[11] Pearson EG,Downey EC,Barnhart DC,et al.Reflux esophageal stricture-a review of 30 years’ experience in children[J].J Pediatr Surg,2010,45(12):2356-2360.DOI:10.1016/j.jpedsurg.2010.08.033.
[12] Arnold M,Numanoglu A.Caustic ingestion in children-A review[J].Semin Pediatr Surg,2017,26(2):95-104.DOI:10.1053/j.sempedsurg.2017.02.002.
[13] Dehghani SM,Honar N,Sehat M,et al.Complications after endoscopic balloon dilatation of esophageal strictures in children.Experience from a tertiary center in Shiraz-Iran (Nemazee Teaching Hospital)[J].Rev Gastroenterol Peru,2019,39(1):7-11.
[14] 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.DOI:10.1016/j.jpedsurg.2013.04.005.
[15] 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.DOI:10.1016/j.jpedsurg.2020.08.017.
相似文献/References:
[1]孔赤寰 马继东 赵英敏 李 龙.球囊扩张治疗先天性食管闭锁术后食管狭窄的时机选择[J].临床小儿外科杂志,2010,9(04):0.
[2]仇学明 罗红来 厉琴 惠亮亮 王美玲 高小花 王震. 食管支架治疗儿童食管烧伤性狭窄[J].临床小儿外科杂志,2011,10(04):279.
[J].Journal of Clinical Pediatric Surgery,2011,10(07):279.
[3]钟微 王哲 余家康 李瑞琼. 先天性食管闭锁/食管气管瘘合并食管狭窄的治疗分析[J].临床小儿外科杂志,2012,11(03):214.
[J].Journal of Clinical Pediatric Surgery,2012,11(07):214.
[4]黄柳明 盛剑秋 刘钢 王伟 余梦楠 段炼 覃胜灵 张瞡.腹腔镜联合食管支架治疗合并食管下端 狭窄的小儿胃食管反流[J].临床小儿外科杂志,2013,12(01):22.
[5]谢乂民 姚明木 吴建国.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[J].临床小儿外科杂志,2015,14(01):54.
[6]顾 松 顾洪斌 马 靖 黄思齐 王 晶 陈其民.可降解镁合金食管支架治疗食管狭窄的动物实验研究[J].临床小儿外科杂志,2018,17(01):60.
Gu Song,Gu Hongbin,Ma Jin,et al.Experimental treatment of esophageal stricture with biodegradable magnesium alloy stent.[J].Journal of Clinical Pediatric Surgery,2018,17(07):60.
[7]赵红梅,张文婷,游洁玉.消化内镜在小儿普外科疾病中的应用进展[J].临床小儿外科杂志,2022,21(07):605.[doi:10.3760/cma.j.cn101785-202206027-002]
Zhao Hongmei,Zhang Wenting,You Jieyu.Application of digestive endoscopy in pediatric surgical diseases[J].Journal of Clinical Pediatric Surgery,2022,21(07):605.[doi:10.3760/cma.j.cn101785-202206027-002]
[8]王跃生,张敬,李小芹,等.加速康复外科理念联合结肠镜技术治疗儿童肠息肉的临床研究[J].临床小儿外科杂志,2022,21(11):1075.[doi:10.3760/cma.j.cn101785-202008070-014]
Wang Yuesheng,Zhang Jing,Li Xiaoqin,et al.Clinical study of enhanced recovery after surgery plus colonoscopy for colorectal polypi in children[J].Journal of Clinical Pediatric Surgery,2022,21(07):1075.[doi:10.3760/cma.j.cn101785-202008070-014]
[9]张芽龙,林燕,惠娅兴,等.改良内镜逆行阑尾炎治疗术在儿童急性非复杂性阑尾炎中的应用研究[J].临床小儿外科杂志,2023,22(03):272.[doi:10.3760/cma.j.cn101785-202209047-013]
Zhang Yalong,Lin Yan,Hui Yaxing,et al.Application of modified endoscopic retrograde appendicitis therapy for acute uncomplicated appendicitis in children[J].Journal of Clinical Pediatric Surgery,2023,22(07):272.[doi:10.3760/cma.j.cn101785-202209047-013]
[10]谷一超,黄金狮,廖俊敏,等.儿童食管腐蚀伤并发症的诊治分析[J].临床小儿外科杂志,2023,22(06):554.[doi:10.3760/cma.j.cn101785-202111049-011]
Gu Yichao,Huang Jinshi,Liao Junmin,et al.Analysis of diagnosing and treating complications related to esophageal corrosion in children[J].Journal of Clinical Pediatric Surgery,2023,22(07):554.[doi:10.3760/cma.j.cn101785-202111049-011]
备注/Memo
收稿日期:2025-2-16。
基金项目:国家临床重点专科重大科研专项资助(Z2023061);湖南省自然科学基金资助项目(2025JJ80102);国家临床重点专科重大科研专项资助(Z2023150)
通讯作者:赵红梅,Email:364875977@qq.com