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(06):554-557.[doi:10.3760/cma.j.cn101785-202111049-011]
儿童食管腐蚀伤并发症的诊治分析
- Title:
- Analysis of diagnosing and treating complications related to esophageal corrosion in children
- Keywords:
- Esophagus; Burns; Chemical; Esophageal Stenosis; Tracheoesophageal Fistula; Diagnosis; Therapy; Treatment Outcome
- 摘要:
- 目的 总结儿童食管腐蚀伤并发症的诊断及治疗经验。方法 本研究为回顾性研究，收集2017年10月至2019年5月由首都医科大学附属北京儿童医院收治的14例食管腐蚀伤病例作为研究对象，总结患儿摄入腐蚀剂后的并发症、治疗和预后情况。结果 14例患儿中，并发食管狭窄12例，其中短段食管狭窄8例，长段食管狭窄4例；14例均行胃镜下球囊扩张术，共扩张188次，有效率为66.7%（8/12），8例短段食管狭窄均扩张成功，4例长段食管狭窄扩张无效。并发食管气管瘘5例，其中3例因纽扣电池导致食管气管瘘的患儿经保守治疗后自愈。结论 儿童食管腐蚀伤可造成食管狭窄，大多可经反复扩张治愈，狭窄段的长度会影响扩张治疗结果。纽扣电池所致食管气管瘘有自愈的可能，可于保守治疗失败后再行手术治疗。
- Abstract:
- Objective To summarize the experiences of diagnosing and treating complications related to esophageal corrosion in children.Methods Retrospective review was conducted for clinical data of 14 children of esophageal corrosive injuries admitted from November 1, 2017 to May 31, 2019.The complications after ingestion of caustic agents, treatments and prognoses were recorded.Results Among them, there were 12 cases esophageal stricture, including short-segment stricture (n=8) and long-segment stricture (n=4).Endoscopy-guided balloon dilatation was employed.The total number of dilatations were 188 with a success rate of 66.7%(8/12).Group of short-segment esophageal stricture had successful dilations while group of long-segment esophageal stricture failed.Five cases of esophagotracheal fistula were complicated and 3 cases due to button battery had spontaneous closure.Conclusion For corrosive esophageal stricture in children, most cases may be cured by repeated dilatation and the length of stricture segment affects the dilatation outcomes.Esophagotracheal fistula due to button battery has the potential of spontaneous closure and surgical intervention should be performed after failed conservative measures.
参考文献/References:
[1] Geng LL, Liang CP, Chen PY, et al.Long-term outcomes of caustic esophageal stricture with endoscopic balloon dilatation in Chinese children[J].Gastroenterol Res Pract, 2018, 2018:8352756.DOI:10.1155/2018/8352756.
[2] 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.DOI:10.4103/0972-5229.171377.
[3] Sami SS, Haboubi HN, Ang Y, et al.UK guidelines on oesophageal dilatation in clinical practice[J].Gut, 2018, 67(6):1000-1023.DOI:10.1136/gutjnl-2017-315414.
[4] Methasate A, Lohsiriwat V.Role of endoscopy in caustic injury of the esophagus[J].World J Gastrointest Endosc, 2018, 10(10):274-282.DOI:10.4253/wjge.v10.i10.274.
[5] 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.
[6] 陈功, 郑珊.儿童食管狭窄的病因及诊治进展[J].临床小儿外科杂志, 2019, 18(6):437-441.DOI:10.3969/j.issn.1671-6353.2019.06.001. Chen G, Zheng S.Etiology, diagnosis and treatment of pediatric esophageal strictures[J].J Clin Ped Sur, 2019, 18(6):437-441.DOI:10.3969/j.issn.1671-6353.2019.06.001.
[7] Siersema PD, de Wijkerslooth LRH.Dilation of refractory benign esophageal strictures[J].Gastrointest Endosc, 2009, 70(5):1000-1012.DOI:10.1016/j.gie.2009.07.004.
[8] 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.DOI:10.3348/kjr.2010.11.2.203.
[9] Joshi P, Yadav R, Dangi A, et al.Corrosive esophageal strictures:from dilatation to replacement:a retrospective cohort study[J].Dysphagia, 2020, 35(4):558-567.DOI:10.1007/s00455-019-10058-1.
[10] Tharavej C, Pungpapong SU, Chanswangphuvana P.Outcome of dilatation and predictors of failed dilatation in patients with acid-induced corrosive esophageal strictures[J].Surg Endosc, 2018, 32(2):900-907.DOI:10.1007/s00464-017-5764-x.
[11] Thomson M, Tringali A, Dumonceau JM, et al.Paediatric gastrointestinal endoscopy:European society for paediatric gastroenterology hepatology and nutrition and European society of gastrointestinal endoscopy guidelines[J].J Pediatr Gastroenterol Nutr, 2017, 64(1):133-153.DOI:10.1097/MPG.0000000000001408.
[12] Tannuri ACA, Tannuri U.Total esophageal substitution for combined hypopharyngeal and esophageal strictures after corrosive injury in children[J].J Pediatr Surg, 2017, 52(11):1742-1746.DOI:10.1016/j.jpedsurg.2017.02.003.
[13] Russell RT, Cohen M, Billmire DF.Tracheoesophageal fistula following button battery ingestion:successful non-operative management[J].J Pediatr Surg, 2013, 48(2):441-444.DOI:10.1016/j.jpedsurg.2012.11.040.
[14] Yal??n ?, Ciftci AO, Karnak ?, et al.Management of acquired tracheoesophageal fistula with various clinical presentations[J].J Pediatr Surg, 2011, 46(10):1887-1892.DOI:10.1016/j.jpedsurg.2011.06.025.
[15] Houas Y, Sahli S, Fitouri F, et al.Spontaneous resolution of a tracheoesophageal fistula caused by button battery ingestion[J].JAMA Otolaryngol Head Neck Surg, 2016, 142(6):609-610.DOI:10.1001/jamaoto.2016.1006.
[16] Contini S, Scarpignato C.Caustic injury of the upper gastrointestinal tract:a comprehensive review[J].World J Gastroenterol, 2013, 19(25):3918-3930.DOI:10.3748/wjg.v19.i25.3918.
[17] ASGE Standards of Practice Committee, Evans JA, Early DS, et al.The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus[J].Gastrointest Endosc, 2012, 76(6):1087-1094.DOI:10.1016/j.gie.2012.08.004.
相似文献/References:
[1]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(06):279.
[2]姚兴伟 韩德志 孙伟晶 于成涌 薛晓蕾 葛亮 陈向军. 早期磨痂治疗小儿面颈部深Ⅱ度烧伤58例[J].临床小儿外科杂志,2011,10(06):476.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):476.
[3]姚兴伟 韩德志 孙伟晶. 自制混合奶在小儿重度烧伤早期胃肠道营养支持中的应用[J].临床小儿外科杂志,2014,13(04):349.
[4]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(06):60.
[5]王萍,李赟,罗欣友,等.22例纽扣式电池食管异物患儿治疗效果分析[J].临床小儿外科杂志,2019,18(06):467.[doi:10.3969/j.issn.1671-6353.2019.06.007]
Wang Ping,Li Yun,Luo Xinyou,et al.The therapeutic effect for 22 children with esophageal foreign bodies of button battery[J].Journal of Clinical Pediatric Surgery,2019,18(06):467.[doi:10.3969/j.issn.1671-6353.2019.06.007]
备注/Memo
收稿日期:2021-11-21。
通讯作者:黄金狮,Email:jsdr2002@126.com