摘要
目的探讨采用经口内镜食管下括约肌切开术治疗儿童贲门失弛缓症的临床应用价值。方法回顾性分析2020年5月至2021年7月就诊于上海市儿童医院的15例贲门失弛缓症患儿临床资料,其中男12例,女3例;年龄为(9.90±2.12)岁,记录围手术期相关情况,分析患儿手术前后Eckardt评分、定时钡餐造影和身体质量指数的差异,定期随访至少3个月以上。符合正态分布的计量资料采用t检验,不符合正态分布的计量资料采用秩和检验。结果15例患儿均成功完成经口内镜食管下括约肌切开术,手术时间为(1.50±0.87)h,隧道总长度为(8.50±1.57)cm,隧道开口距胃食管连接部长度为(6.55±1.23)cm,肌切开长度为(3.90±0.94)cm。15例患儿中,1例术中出现胃穿孔,予钛夹夹闭创口,术后愈合;5例术后皮下气肿,均自行吸收,其他并发症包括发热2例,胃食管反流1例。随访3~17个月,所有患儿吞咽困难等症状明显缓解。Eckardt评分术后3个月(0.10±0.30)分低于术前(4.70±1.35)分,差异有统计学意义(P<0.001),定时钡餐造影5 min钡剂高度术后(1.12±1.45)cm低于术前(11.55±3.52)cm,差异有统计学意义(P<0.001),中位身体质量指数术后高于术前,差异有统计学意义(17.95 kg/m^(2)比14.30 kg/m^(2),P=0.009)。结论经口内镜食管下括约肌切开术治疗儿童贲门失弛缓症安全有效、具有可操作、微创术后恢复快的优点,其远期并发症及疗效仍需进一步的观察随访。
Objective To explore the clinical value of peroral endoscopic myotomy(POEM)for achalasia in children.Methods From May 2020 to July 2021,the relevant clinical data were retrospectively reviewed for 15 children with achalasia.There were 12 boys and 3 girls with an age range of(9.90±2.12)year.Perioperative outcomes were recorded and differences in Eckardt score,barium meal and body mass index(BMI)examined before and after surgery.Each child was followed for at least 3 months.And t-test was utilized for measures conforming to a normal distribution and rank-sum test for measures not conforming to a normal distribution.Results All procedures were performed successfully.Operative duration was(1.50±0.87)hour,total tunnel length(8.50±1.57)cm,length of tunnel opening to esophagogastric junction(EGJ)(6.55±1.23)cm and myotomy length(3.90±0.94)cm.One child developed gastric perforation during operation and wound healed well after titanium clipping.Five cases of postoperative subcutaneous emphysema were self-absorbed.Other complications included fever(n=2)and reflux(n=1).During a follow-up period of(3-17)months,dysphagia and other symptoms were markedly relieved.Eckardt score was lower at Month 3 postoperatively than preoperatively[(0.10±0.30)vs(4.70±1.35)]and the difference was statistically significant(P<0.001).The postoperative barium height at 5 min was also lower than preoperative[(1.12±1.45)vs(11.55±3.52)cm]and the difference was statistically significant(P<0.001).Postoperative median BMI was higher and the difference was statistically significant(17.95 vs 14.3 kg/m^(2),P=0.009).Conclusions POEM is safe,effective,feasible and mini-invasive for achalasia in children.However,further observations and follow-ups are required for its long-term complications and efficacy.
作者
冯玉灵
刘海峰
叶国刚
张儒舫
顾竹珺
林凯
汪星
Feng Yuling;Liu Haifeng;Ye Guogang;Zhang Rufang;Gu Zhujun;Lin Kai;Wang Xing(Department of Endoscopy Center,Affiliated Shanghai Children's Hospital,Shanghai Jiao Tong University school of Medicine,Shanghai 200062,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2023年第10期922-926,共5页
Chinese Journal of Pediatric Surgery
