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目的总结Collis联合胃底折叠术治疗2例儿童先天性食管下段狭窄的诊治体会。方法 2015年12月及2016年6月收治2例先天性食管下段狭窄男性患儿,年龄均为2岁;均有反复呕吐史,伴营养不良。其中1例因重度营养不良行胃造瘘术,8个月后行该次手术。术前2例均行食管下端球囊扩张1次无效。行Collis术联合胃底折叠术,同时行幽门成形。结果 2例手术均顺利完成,手术时间分别为120、180 min,术中出血量15、20 mL。狭窄段组织病理检查提示为异位气管支气管软骨。术后1周上消化道造影示吻合口无狭窄及漏,无明显胃食管反流。2例患儿均获随访,均开始进普食,无吞咽困难;体质量较术前明显增加。术后6个月上消化道造影检查示吻合口通畅。结论 Collis联合胃底折叠术是治疗儿童先天性食管下段狭窄的一种较好方法,合理的手术方案设计和手术精细化操作,可以减少术后并发症。
Objective To summarize the experience of treatment and treatment of congenital lower esophageal stenosis in children with Collis combined with fundoplication. Methods Two children with congenital esophageal stenosis were treated in December 2015 and June 2016, both of whom were 2 years old. Both had history of recurrent vomiting and malnutrition. One case of gastrostomy due to severe malnutrition, 8 months after the operation. Preoperative 2 patients underwent esophageal balloon dilatation 1 invalid. Collis surgery combined with fundoplication, while pylorus formation. Results Two cases of operation were successfully completed. The operation time was 120,180 min and the intraoperative blood loss was 15,20 mL. Histopathological examination of the narrow segment suggests ectopic tracheal bronchus cartilage. One week after operation, upper gastrointestinal angiography showed no anastomotic stenosis and leakage, no obvious gastroesophageal reflux. Two cases of children were followed up, began to eat the general diet, no dysphagia; body mass was significantly increased compared with preoperative. Upper gastrointestinal tract imaging showed anastomotic patency 6 months after surgery. Conclusion Collis combined with fundoplication is a better method for the treatment of congenital esophageal stenosis in children. The rational surgical design and operation of fine operation can reduce postoperative complications.