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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2017, Vol. 13 ›› Issue (03) : 310 -315. doi: 10.3877/cma.j.issn.1673-5250.2017.03.012

所属专题： 文献；

论著

胃镜下探条扩张术治疗先天性食管闭锁修补术后吻合口狭窄及相关因素分析
邓孝智1, 熊励晶1, 向梅1, 袁岚1, 张利兵2, 郭浪涛3, 闫焕2, 商丽红1, 谢晓丽1,†()   
  1. 1. 610031　成都市妇女儿童中心医院儿童消化科
    2. 610031　成都市妇女儿童中心医院小儿外科
    3. 610031　成都市妇女儿童中心医院麻醉科
  • 收稿日期:2017-01-10 修回日期:2017-03-25 出版日期:2017-06-01
  • 通信作者: 谢晓丽

Clinical application of gastroscopic bougie dilatation in treatment of anastomotic stricture after surgical repair of congenital esophageal atresia and analysis of influencing factors

Xiaozhi Deng1, Lijing Xiong1, Mei Xiang1, Lan Yuan1, Libing Zhang2, Langtao Guo3, Huan Yan2, Lihong Shang1, Xiaoli Xie1,†()   

  1. 1. Department of Pediatrics Gastroenterology, Chengdu Women′s and Children′s Central Hospital, Chengdu 610091, Sichuan Province, China
    2. Department of Pediatrics Surgery, Chengdu Women′s and Children′s Central Hospital, Chengdu 610091, Sichuan Province, China
    3. Department of Anesthesia, Chengdu Women′s and Children′s Central Hospital, Chengdu 610091, Sichuan Province, China
  • Received:2017-01-10 Revised:2017-03-25 Published:2017-06-01
  • Corresponding author: Xiaoli Xie
  • About author:
    Corresponding author: Xie Xiaoli, Email:
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引用本文：

邓孝智, 熊励晶, 向梅, 袁岚, 张利兵, 郭浪涛, 闫焕, 商丽红, 谢晓丽. 胃镜下探条扩张术治疗先天性食管闭锁修补术后吻合口狭窄及相关因素分析[J]. 中华妇幼临床医学杂志(电子版), 2017, 13(03): 310-315.

Xiaozhi Deng, Lijing Xiong, Mei Xiang, Lan Yuan, Libing Zhang, Langtao Guo, Huan Yan, Lihong Shang, Xiaoli Xie. Clinical application of gastroscopic bougie dilatation in treatment of anastomotic stricture after surgical repair of congenital esophageal atresia and analysis of influencing factors[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(03): 310-315.

目的

探讨胃镜下探条扩张术治疗先天性食管闭锁(CEA)修补术后吻合口狭窄的临床应用与疗效，以及多次胃镜下探条扩张术的相关影响因素。

方法

选择2011年11月至2014年6月，成都市妇女儿童中心医院收治的因CEA修补术后吻合口狭窄施行胃镜下探条扩张术治疗的25例患儿为研究对象。根据患儿接受的胃镜下探条扩张术治疗次数，将其分为A组(n＝11，扩张术治疗次数≤2次)与B组(n＝14，扩张术治疗次数>2次)。统计学比较2组患儿的胃镜下探条扩张术相关因素。对2组胃镜下探条扩张术治疗后存活的患儿，于末次扩张术治疗后开始随访，随访内容主要包括进食及生长发育情况，随访时间截至2015年9月。对2组患儿随访结果进行统计分析。本研究遵循的程序符合成都市妇女儿童中心医院人体试验委员会制定的伦理学标准，并得到医院伦理委员会批准，同时与受试者家长均签署临床研究知情同意书。2组患儿的年龄、性别构成比等基本临床资料比较，差异均无统计学意义(P>0.05)。

结果

①本研究25例CEA修补术后吻合口狭窄患儿，首次接受胃镜下探条扩张术治疗时的年龄为27～575 d；所有患儿共计接受胃镜下探条扩张术治疗76次，每例患儿平均约接受3次胃镜下探条扩张术治疗；胃镜下探条扩张术后并发症：1例患儿术后发生食管瘘，1例患儿发生食管水肿。②本研究A组患儿末次胃镜下探条扩张术治疗前狭窄指数(SI)值显著高于B组患儿，末次胃镜下探条扩张术探条最大直径显著小于B组患儿，并且差异均有统计学意义(t＝3.829，P＝0.002；t＝4.263，P<0.001)。③本研究接受治疗的25例患儿中，1例患儿因末次胃镜下探条扩张术后发生食管瘘而死亡。对存活的24例患儿于末次胃镜下探条扩张术后的进食及生长发育情况进行随访，随访时间最长为42个月，平均为7.4个月；91.2%(22/24)患儿生长发育正常；1例患儿发生食管水肿，1例患儿发生胃食管反流。截至随访结束时，所有患儿均无明显吞咽困难及食物梗阻症状，无一例患儿因食管狭窄再次接受胃镜下探条扩张术治疗。

结论

胃镜下探条扩张术治疗CEA修补术后吻合口狭窄患儿，安全、有效。多次扩张可增加患儿食管直径，从而改善吞咽困难症状。因本研究纳入样本量较小，尚需更多大样本、多中心、随机对照试验进一步探讨导致胃镜下探条扩张术治疗次数增多的原因，以及证实胃镜下探条扩张术治疗CEA修补术后吻合口狭窄的确切疗效。

关键词: 先天性食管闭锁, 吻合口狭窄, 探条扩张术, 胃镜检查, 儿童
Objective

To evaluate the clinical application and therapeutic effect of gastroscopic bougie dilatation in treatment of anastomotic stricture after surgical repair of congenital esophageal atresia (CEA) and preliminary explore the influencing factors associated with repeated gastroscopic bougie dilatations.

Methods

A total of 25 cases of infants who received gastroscopic bougie dilatation treatment in Chengdu Women′s and Children′s Central Hospital due to anastomotic stricture after surgical repair of CEA were chosen as research subjects. They were divided into group A (n=11, dilatation times≤2 times) and group B (n=14, dilatation times>2 times) according to the times of gastroscopic bougie dilatation. The influencing factors associated with repeated gastroscopic bougie dilatations were analyzed between two groups by statistical methods. Follow-up of survival children were conducted after the last dilatation including diet condition and nutrition status and the follow-up deadline was September 2015. The follow-up results of two groups were statistically analyzed. This study was approved by the Ethical Review Board of Investigation in Human Being of Chengdu Women′s and Children′s Central Hospital. All the parents of the infants signed informed consents. There were no statistically significant differences between two groups in the age, gender ratio and the other basic clinical data (P>0.05).

Results

①As to the 25 children with anastomotic stricture after surgical repair of CEA, the ages of initial gastroscopic bougie dilatation were 27-575 days. All the children received 76 times of successful gastroscopic bougie dilatations and each received an average of 3 times of dilatation. And 2 children had complications including esophageal fistula and esophageal edema, respectively. ②The value of structure index (SI) before the last gastroscopic bougie dilatation in group A was higher than that in group B, while the largest diameter of bougie was lower than that in group B, and both the differences were statistically significant (t=3.829, P=0.002; t=4.263, P<0.001). ③One case of child died with esophageal fistula after the last gastroscopic bougie dilatation. So 24 survival children were enrolled in the follow-up, the longest follow-up time was 42 months and the mean time was 7.4 months. The growth and development of 91.2% (22/24) children were in normal range. Esophageal edema and gastroesophageal reflux were occurred in two children, respectively. All children had no obvious dysphagia and food obstruction symptoms and none of the children received gastroscopic bougie dilatation again at end of follow-up.

Conclusions

Gastroscopic bougie dilatation is effective and safe for the treatment of anastomotic stricture after surgical repair of CEA. Repeated gastroscopic bougie dilatations lead to bigger diameter of esophageal and improvement of dysphagia. As the sample size in this study is relatively small, more large sample, multi-center, randomized controlled clinical trials are required to explore the causes of repeated gastroscopic bougie dilatations in treatment of anastomotic stricture after surgical repair of CEA, and to confirm the exact therapeutic effect of gastroscopic bougie dilatation in treatment of anastomotic stricture after surgical repair of CEA.

Key words: Congenital esophageal atresia, Anastomotic stricture, Bougie dilatation, Gastroscopes, Child
图1 1例月龄为1个月的先天性食管闭锁修补术后吻合口狭窄男性患儿接受胃镜下探条扩张术治疗情况(图1A：胃镜下探条扩张术前；图1B；胃镜下探条扩张术中；图1C：胃镜下探条扩张术后)
表1 2组先天性食管闭锁修补术后吻合口狭窄患儿胃镜下探条扩张术相关因素比较
组别 例数 性别(男/女) 首次扩张术时的年龄[d，M(P25～P75)] 首次扩张术前SI值(±s) 首次扩张术探条使用数[根，M(P25～P75] 首次扩张术探条最大直径[mm，M(P25～P75] 末次扩张术时的年龄(d，±s) 末次扩张术前SI值(±s) 末次扩张术探条使用数[根，±s]
A组 11 5/6 59.0(38.8～201.5) 0.5±0.1 2.0(2.0～2.0) 7.0(7.0～7.5) 226.0±201.6 0.5±0.1 2.2±0.6
B组 14 8/6 53.5(36.5～56.0) 0.7±0.1 1.5(1.0～2.0) 7.0(7.0～7.0) 415.1±282.8 0.4±0.1 1.8±0.8
检验值 ? － Z＝1.049 t＝0.895 Z＝1.281 Z＝2.038 t＝2.146 t＝3.829 t＝1.344
P值 ? 0.272 0.317 0.850 0.277 0.201 0.054 0.002 0.189
组别 例数 末次扩张术探条最大直径(mm, ±s) 首次扩张术前合并吞咽困难症状(n/n′) 末次扩张术前合并吞咽困难症状(n/n′)
无呕吐 进食半流质体食物后呕吐 进食流质体食物后呕吐 无呕吐 进食固体食物后呕吐 进食半流质体食物后呕吐 进食流质体食物后呕吐
A组 11 9.2±1.6 3/11 1/11 7/11 3/11 3/11 2/11 3/11
B组 14 11.9±1.7 4/14 1/14 9/14 7/14 3/14 2/14 2/14
检验值 ? t＝4.263 χ2＝1.461 χ2＝2.063
P值 ? <0.001 0.691 0.457
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