Gu Yichao,Huang Jinshi,Chen Yongwei,et al.Analysis of effectiveness of endoscopy-guided balloon dilatation for anastomotic strictures after repairing esophageal atresia[J].Journal of Clinical Pediatric Surgery,2019,18(06):450-455.[doi:10.3969/j.issn.1671-6353.2019.06.004]
胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄的疗效分析
- Title:
- Analysis of effectiveness of endoscopy-guided balloon dilatation for anastomotic strictures after repairing esophageal atresia
- Keywords:
- Gastroseopy; Esophageal Atresia/SU; Esophageal Atresia/TH; Stomas
- 分类号:
- R655.4;R616.5
- 摘要:
- 目的 探讨胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄的安全性及有效性。方法 本研究回顾性收集2017年11月1日至2018年10月31日由首都医科大学附属北京儿童医院收治的61例先天性食管闭锁术后吻合口狭窄病例作为研究对象，其中12例为本院食管闭锁术后患儿。根据患儿辅食添加情况，将首次扩张年龄分为<3个月（n=19），3~6个月（n=12），6~12个月（n=9）和 ≥ 12个月（n=21）4组。症状缓解持续1个月以上，不需要扩张者被认为短期成功；症状缓解持续3个月以上，不需要扩张者被认为中期成功。结果 61例患儿共扩张331次，单人扩张次数1~13次，扩张次数的中位数和四分位间距为5（IQR：3~7）次。首次扩张年龄 < 3个月的患儿，扩张次数的中位数和四分位间距为4（IQR：3~7）次，扩张终点球囊直径为（8.3±1.2）mm。首次扩张年龄为3~6个月者扩张次数的中位数和四分位间距为5（IQR：3.25~7.0）次，扩张终点球囊直径为（10.1±2.0）mm。首次扩张年龄为6~12个月者扩张次数的中位数和四分位间距为9（IQR：6.5~11.5）次，扩张终点球囊直径为（12.3±2.3）mm。≥ 12个月的患儿扩张次数的中位数和四分位间距为4（IQR：2~6）次，扩张终点的球囊直径为（13.6±1.7）mm。不同年龄组扩张次数存在统计学差异（H=94.258，P<0.001）。不同年龄组扩张终点球囊直径存在统计学差异（F=33.147，P<0.001）。61例患儿中，短期扩张成功率为72.1%，中期扩张成功率为59.0%。1例发生穿孔，经保守治疗后痊愈，穿孔率为0.3%（1/331）。结论 胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄，疗效满意，并发症少，可作为治疗的第一选择。
- Abstract:
- Objective To evaluate the safety and effectiveness of endoscopy-guided balloon dilatation for anastomotic strictures (AS) after repairing esophageal atresia (EA). Methods A retrospective study was conducted for clinical data of 61 AS children undergoing endoscopy-guided balloon dilatation for repairing EA from October 31,2017 to November 1,2018.And 12 of them were operated at our hospital.According to the addition status of food supplements,they were divided into four groups of <3 months (n=19),3-6 months (n=12),6-12 months (n=9) and >1 year (n=21).Short-term success was defined as symptom relief for >1 month and there was no need for dilation.And symptom relief of medium-term success lasted >3 months and no dilation was required.Results A total of 61 children underwent 331 dilatations and the median/quartile number of dilations was 5(3-7).For those children whose initial dilations were performed at an age of <3 months,the median/quartile number of dilations was 4(3-7).And the median terminal diameter of balloon was 8.3 1.2 mm,the median/quartile number of dilation 5(3.25-7.0) and the median terminal diameter of balloon 10.1 2.0 mm in children whose initial dilations were performed at an age of 3 to 6 months.Among those children with initial dilation at an age of 6-12 months,the median/quartile number of dilations was 9(6.5-11.5) and the median terminal diameter of balloon 12.3 2.3 mm.For those children with initial dilation at an age of >12 months,the median/quartile number of dilations was 4(2-6) and the median terminal diameter of balloon 13.6 1.7 mm.The difference of dilation numbers was significant among four groups (H=94.258,P<0.001).There is a significant statistical difference on the terminal diameter in the 4 groups (F=33.147,P<0.001).The percentages of short and medium-term success were 72.1% and 59.0% respectively.And only one case of esophageal perforation was cured with conservative measures.And the rate of perforation was 0.3% (1/331). Conclusion Endoscopy-guided balloon dilatation has excellent outcomes with few complications and it may be a priority choice for treatment.
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备注/Memo
收稿日期:2019-04-20。
通讯作者:黄金狮,Email:jsdr2002@126.com