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1 临床资料患儿女,3岁。因进食后呕吐伴消瘦2年余,于1991年3月24日入院。患儿出生后吃奶易吐,8个月时呕吐频繁,逐渐加重,口服药物治疗无效。查体:体重8kg,发育及营养差,消瘦,舟状腹。食管钡剂造影见食管下段狭窄,钡剂呈线状通过,其上方食管扩张,呈“萝卜根”状,食管粘膜光整。临床诊断:(1)食管下段狭窄(贲门失弛缓症);(2)二度营养不良。术中见食管下段长5cm狭窄,质硬,周围无粘连,淋巴结不肿大。狭窄段以上食管明显扩张。纵行切开狭窄段食管肌层,发现肌层组织较厚、质硬,食管粘膜菲薄。切除狭窄食管,行胃食管吻合术。切除标本送病理检查。
1 Children with clinical data, 3 years old. She was admitted to hospital on March 24, 1991 because of vomiting after eating for more than two years. After the baby was born, it was easy to vomit, and vomiting was frequent at 8 months and gradually worsened. Oral medication was not effective. Physical examination: body weight 8 kg, poor development and nutrition, weight loss, boat-shaped abdomen. The esophageal barium contrast agent showed a narrow esophageal stenosis, and the barium passed linearly. The upper part of the esophagus expanded and showed a “radish root” shape and the esophageal mucosa was smooth. Clinical diagnosis: (1) stenosis of the lower esophagus (achalasia); (2) secondary malnutrition. During the operation, the length of the lower esophageal stenosis was 5cm, hard, surrounded by no adhesion, and the lymph nodes were not enlarged. The esophagus was significantly expanded above the stenosis. The longitudinal section of the esophagus in the narrow section of the esophagus revealed a thicker, stiffer muscular tissue and a thin esophageal mucosa. The narrow esophagus was removed and gastroesophageal anastomosis was performed. Resection specimens for pathological examination.