球囊扩张术在小儿食道狭窄及贲门失弛缓中的应用分析

Endoscopic balloon dilatation of esophageal stricture and esophageal achalasia in children

摘要:

目的 比较球囊扩张术（EBD）治疗小儿食道狭窄及贲门失弛缓的疗效，分析预后影响因素。 方法 2012 年1 月-2014 年12 月共28 例患儿纳入研究。其中，食道狭窄22 例，贲门失弛缓6 例，利用扩张 球囊进行治疗。结果 28 例患儿共接受57 次球囊扩张术，随访12 ～ 36 个月，28 例全部成功。其中，23 例患 儿症状完全缓解（82.14%），4 例患儿部分缓解（14.28%），1 例无效（3.57%），1 例复发（3.57%）。治疗成功率、 有效率、并发症发生率及复发率两组患儿比较差异无统计学意义。食道狭窄患儿中，多个狭窄患儿并发症较 单个狭窄患儿多，狭窄直径越小并发症越多，比较差异有统计学意义（P <0.05）；治疗效果与狭窄直径和狭窄 个数显著相关（P <0.05）。贲门失弛缓组患儿中，发病年龄及明确诊断前症状持续的时间均对EBD 治疗效果 没有显著影响。结论 EBD 是小儿食道狭窄及贲门失弛缓安全有效的治疗手段；狭窄直径和狭窄个数是影响 食道狭窄治疗效果最重要的因素，而第一次球囊扩张与食道闭锁手术之间的时间则是术后食道狭窄患儿最重 要的影响因素。

Abstract:

Objective To assess the safety, effectiveness and predictive factors of endoscopic balloon dilatation for the treatment of esophageal stricture and esophageal achalasia in children. Methods 28 patients with esophageal stricture and esophageal achalasia treated by endoscopic balloon dilatation from January 2012 to November 2014 were included. All the patients were divided into two groups, 22 in group A (esophageal stricture) and 6 in group B (esophageal achalasia). All procedures were performed under tracheal intubation and intravenous anesthesia using the 3rd grade controlled radial expansion (CRE) balloon with gastroscope. Outcomes, including success, complications and recurrence data were recorded, and predictors for outcomes were analyzed. Results A total of EBD 57 sessions (1 to 5 per patient, 2.00 ± 1.15) were performed on 28 patients in this study. 22 patients were diagnosed with esophageal stricture (78.57%) and 6 with esophageal achalasia (21.43%). The median age was 25 months (range 0 ~ 150), and female/ male ratio was 12/16. EBD was successful in all the 28 cases. The total success rate was 100.00%. Complications occurred in 6 patients during the dilatation, and no complication in 22 patients. Completely remission of symptoms was seen in 82.14% cases (n = 23), relief in 14.28% (n = 4), non-response in 3.57% (n = 1), and recurrence in 3.57% (n = 1). The stricture diameter before EBD was (6.28 ± 1.77) mm (range 3.0 ~ 10.0 mm), and it was (10.85 ± 2.51) (range 6 ~ 15 mm) after the last EBD. The difference was significant (P < 0.01). There was no significant difference in success, effectiveness, complications and recurrence among the two groups (P > 0.05). The effectiveness of EBD was significantly associated with the diameter and number of strictures (P < 0.05), more complications were seen in the patients with multiple and/or smaller strictures (P < 0.05). In group A, the longer interval between surgery and the first EBD was related to more dilatation in the patients with anastomotic esophageal strictures (P < 0.05). The age and the interval between symptom onset and the first EBD were not the predicting factors for treatment in group B (P > 0.05). Conclusions The results of this study indicated that EBD under general anesthesia was an effective primary treatment in children with esophageal stricture and esophageal achalasia. The diameter and number of stricture were the most important predictive factors for successful clinical outcomes, while the interval between surgery and the first EBD was the most risk factor for EBD sessions in the patients with anastomotic esophageal strictures.