内镜下球囊扩张术治疗新生儿食管闭锁术后食管狭窄的临床研究

A clinical study of endoscopic balloon dilation in treatment of esophageal stenosis after neonatal esophageal atresia surgery

摘要:

目的 探讨内镜下球囊扩张术治疗先天性食管闭锁术后食管狭窄的可行性及疗效。 方法 回顾性分析郑州儿童医院新生儿外科2009年1月至2017年12月行手术治疗的218例Ⅲ型食管闭锁患儿资料，分析术后并发症发生情况，食管狭窄内镜下球囊扩张术治疗效果。 结果 218例患儿中，Ⅲa型92例，Ⅲb型126例。术后发生吻合口瘘46例（21.1％），其中Ⅲa型29例（31.5％），Ⅲb型17例（13.5％）；发生吻合口狭窄53例（24.3％），其中Ⅲa型29例（31.5％），Ⅲb型24例（19.0％），食管闭锁不同分型吻合口瘘及吻合口狭窄发生率比较差异有统计学意义（χ2=10.383，P=0.001； χ2=4.497，P=0.034）。53例吻合口狭窄患儿行内镜下球囊扩张术123例次，每例（3.5±1.6）次，临床痊愈，无食管穿孔等不良事件发生。其中Ⅲa型扩张73例次，每例（4.0±1.8）次；Ⅲb型扩张50例次，每例（2.5±0.7）次；Ⅲa型患儿术后食管狭窄扩张次数更多（t=-4.053，P=0.027）。 结论 Ⅲa型食管闭锁较Ⅲb型术后吻合口狭窄及吻合口瘘发生率高，食管扩张次数更多。内镜下球囊扩张术是治疗食管闭锁术后食管狭窄安全、有效的方法。

Abstract:

Objective To explore the feasibility and efficacy of endoscopic balloon dilation in treatment of esophageal stenosis caused by operation of congenital esophageal atresia. Methods A retrospective analysis was performed on data of 218 children with type Ⅲ esophageal atresia， who underwent surgery in Zhengzhou Children′s Hospital from January 2009 to December 2017. The occurrence of postoperative complications and efficacy of endoscopic balloon dilation in treatment of esophageal stenosis was analyzed. Results Among the 218 patients with congenital esophageal atresia， 92 were type Ⅲa and 126 were type Ⅲb. Postoperative anastomotic leakage occurred in 46 cases （21.1％）， including 29 （31.5％） of type Ⅲa and 17 （13.5％） of type Ⅲb. Postoperative anastomotic stenosis occurred in 53 cases （24.3％）， including 29 （31.5％） of type Ⅲa and 24 （19.0％） of type Ⅲb. The incidence of anastomotic leakage and anastomotic stenosis in different types was significantly different （χ2=10.383， P=0.001； χ2=4.497， P=0.034）. The 53 cases of anastomotic stenosis underwent 123 times of endoscopic balloon dilation， with mean time of 3.5±1.6， and were finally clinically recovery. No esophagus perforation occurred. Among them， 29 cases of type Ⅲa underwent 73 times with mean of 4.0±1.8， and 24 cases of type Ⅲb underwent 50 times with mean of 2.5±0.7. The difference between the two types was statistically significant （t=-4.053， P=0.027）. Conclusion Children with type Ⅲa esophageal atresia has a higher incidence of anastomotic stenosis and leakage， and more times of esophageal dilation. Endoscopic balloon dilation is safe and effective in treatment of esophageal stenosis after surgery for patients with congenital esophageal atresia.