摘要
目的 根据病理结果 ,探讨小儿先天性食管狭窄的早期诊断和改良的治疗方案。方法 回顾性分析 1 980～ 2 0 0 0年 4 2例先天性食管狭窄病例的呕吐发生年龄、频率 ,对营养、发育的影响 ,诊断治疗方法及病理所见 ,术后正常进食时间 ,远期营养恢复。结果 经食管镜、消化道造影、手术病理证实 ,气管软骨异位 2 6例 ,肌层肥厚 1 1例 ,膜式狭窄 3例 ,异位胃黏膜 2例。 4 2例中 1 1例先行扩张治疗者仅 1例膜式狭窄扩张成功 ;4 1例手术治疗 ,1 0例端端吻合 ,1 2例食管胃吻合 ,1 9例纵切横缝。 9例术后扩张。扩张 3个月以上者占 5 5 6 %。膜式狭窄、气管软骨异位术后见效快 ,大多无需扩张。肌层肥厚多数需术后扩张 ,但随访 4～ 1 0年效果良好。术后病程 1个月即恢复正常进食者达 78 6 %,6个月 9 5 %,1年始恢复者为 1 1 9%。结论 注意添加辅食时频繁呕吐影响营养、发育者 ,可早发现本病 ;食管镜、消化道造影是诊断依据。膜式狭窄、气管软骨异位 ,纵切横缝效果好。肌层肥厚行狭窄段切除端端吻合是基本治疗方法 ;术后 1个月扩张疗效满意。
Objective Base on the local pathology, the early diagnosis and a reasonable treatment for congenital esophageal stenosis (CES) were discussed. Methods Forty two cases of congenital esophageal stenosis during 1980～2000 were reviewed retrospectively, including age, vomitus and frequency, nutrition and development, diagnostic method used and operative pathological findings, time of normal feeding and time of nutritional restoration. Results According to local pathology, there were 26 cases of tracheobronchial remnant, 11 fibromuscular stenosis, 3 membranous diaphragm, and 2 ectopic gastric mucosa. Membranous diaphragm excision gave the best result without postoperative dilatation. The patients were followed up for 4～10 years, Normal feeding was restored in 1 month in 78 6%, 9 5% in 6 months, and 11 9% in 1 year. Conclusion Persistent vomiting of undigested food and failure in gaining weight are the chief complaints of congenital esophageal stenosis. The confirmatory diagnosis depends on barium swallowing and esophagoscopy. A good result can be achieved by follows local resection and necessary postoperative dilatation.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2004年第5期257-258,共2页
Chinese Journal of Thoracic and Cardiovascular Surgery
