摘要
目的探讨腹腔镜胃造口术联合Forley尿管球囊扩张治疗小儿瘢痕性食管狭窄的可行性和疗效。方法自2006年7月至2014年2月间河北医科大学第二医院小儿外科收治瘢痕性食管狭窄患儿11例，男8例，女3例，年龄（39．27±29．32）个月。均于全身麻醉下行腹腔镜胃造口术，术后第7天利用简易Forley尿管球囊进行狭窄食管扩张。于术后1个月、3个月、6个月、1年、2年回院复查，食管钡餐检查，测量对比术后食管扩张不同时间段狭窄段食管直径变化。结果所有11例患儿均顺利完成手术，手术时间（24．01±5．02）min，出血量（15．91±4．37）ml，术后住院（8．18±0．98）d。术后第7天开始扩张食管，操作顺利。扩张1个月后，4例可进少量固体食物；3个月时，9例可进普通饮食；6个月时，患儿几乎全部恢复正常饮食。术后1～3个月期间食管扩张效果最明显，与其他时间段比较均有显著型差异（F=13．407，P=0．000〈0．01）。术后造瘘口周围皮炎或湿疹8例，造瘘口脱垂1例，扩张后食管黏膜出血2例，无造瘘口回缩、食管破裂穿孔、导丝或尿管断裂、腹膜炎等发生。结论腹腔镜胃造口术联合Forley尿管球囊扩张治疗小儿瘢痕性食管狭窄，损伤轻、出血少、恢复快，采用器械简单，操作方法简易，疗效明显。
Objective To explore the feasibility and efficacy of using Forley＇s catheter joint balloon dilatation for pediatric cicatricial esophageal stenosis during laparoscopic gastrostomy. Methods From July 2006 to February 2014, ll children （8 boys; 3 girls） with cicatricial esophageal stenosis with an age range of 39. 27 ＋ / - 29. 32 months were recruited. Laparoscopic gastrostomy was performed under general anesthesia and balloon dilatation with a simple Forley＇s catheter as of Day 7 post-operation. And the postoperative follow-ups were conducted at 1 month, 3 months, 6 months, 1 year and 2 years. Contrast esophagography was performed. And the variations of esophageal diameters for narrow segments were measured and compared in different postoperative periods. Results Laparoscopic gastrostomy was successfully performed with an operative duration of 24. 01 ＋ / - 5.02 min, intraoperative blood loss of 15.91 ＋ / - 4. 37 milliliters and a postoperative hospital stay of 8. 18 ＋ / - 0. 98 days. Balloon dilatation of esophageal stenosis was performed smoothly. After 1-month dilatation, 4 cases could take a small amount of solid food. At 3 months, a normal diet resumed in 9 cases. Almost all children received a normal diet 6 months later. The most obvious dilatations occurred at 1 to 3 months. The variations of esophageal diameters for narrow segments were significantly obvious compared with other time periods （F = 13. 407, P = 0. 000〈0. 01）. Complications included fistula dermatitis or eczema （n = 8）, stoma prolapse （n = 1） and esophageal mucosal hemorrhage （n = 2）. There was no onset of stoma retraction, esophagus perforation, thread/ catheter rupture or peritonitis. Conclusions Laparoscopic gastrostomy joint balloon dilatation by Forley＇s catheter can manage cicatricial esophageal stenosis effectively. And it has the advantages of less trauma, less bleeding, faster recovery, simple equipment and easy handling.
出处
《中华小儿外科杂志》
CSCD
2016年第1期48-52,共5页
Chinese Journal of Pediatric Surgery
基金
国家卫计委重大公益性行业科研专项项目（201402007）
