内镜下放射状切开术治疗小儿食管良性狭窄的疗效评估

Evaluation of endoscopic radial incision for benign esophageal stenosis in children

摘要:

目的 评价内镜下放射状切开术（ERI）对于小儿食管良性狭窄的疗效和安全性。 方法 回顾西安市儿童医院2013年1月至2018年5月期间接受ERI治疗的20例食管狭窄患儿的临床资料，总结手术情况、临床症状改善情况、手术相关并发症等。 结果 20例患儿均顺利完成ERI治疗，中位手术时间10 min（5～25 min），中位狭窄环切开次数4次（1～8次）。所有患儿术后未出现发热、胸骨后疼痛、出血及穿孔等现象。住院时间4.5 d（4～7 d）。术后随访3～24个月，平均7.9个月。20例患儿术后1个月复查，狭窄口较术前扩张［1.0 cm（0.6～1.5 cm）比0.3 cm（0.1～0.5 cm），t=11.018，P＜0.001］，吞咽困难评分较术前下降［0分（0～2分）比2.5分（2～4分），Z=4.027，P＜0.001］。19例患儿术后3个月体重增加2 kg（1～4 kg）。相关性分析显示，ERI术后吞咽困难改善程度与性别、年龄、术前治疗次数、术前狭窄口直径均无明显关系（P均＞0.05），而与狭窄段长度负相关（r=-0.514，P=0.020）。 结论 ERI治疗小儿食管良性狭窄是安全有效的，值得临床推广。

Abstract:

Objective To evaluate the efficacy and safety of endoscopic radial incision （ERI） for treatment of benign esophageal stenosis in children. Methods A retrospective analysis was performed on clinical data of 20 children with benign esophageal stenosis who underwent ERI from January 2013 to May 2018 in Xi′an Children′s Hospital. The procedure， improvement of clinical symptoms， and complications related to the operation were analyzed. Results All 20 patients were successfully treated with ERI， with median operation time of 10 min （5-25 min）， and median number of narrow ring incision of 4 times （1-8 times）. No fever， poststernal pain， bleeding or perforation was found in any child after operation. The hospital stay was 4-7 days， with a median of 4.5 days. The postoperative follow-up was 3-24 months， with an average of 7.9 months. At one month after operation， the stenosis diameter of 20 cases was enlarged［1.0 cm （0.6-1.5 cm） VS 0.3 cm （0.1-0.5 cm）， t=11.018， P＜0.001］， and dysphagia score was lower［0 （0-2） VS 2.5 （2-4）， Z=4.027， P＜0.001］ compared with that before. The median weight of 19 children increased by 2 kg （1-4 kg） three months after operation. There was no significant correlation between improvement of dysphagia after ERI and sex， age， times of preoperative treatment and diameter of stenosis （all P＞0.05）， but there was a negative correlation between improvement of dysphagia after ERI and the length of stenosis （r=-0.514， P=0.020）. Conclusion ERI is safe and effective for treatment of benign esophageal stenosis in children， which can be recommended in clinic.