本文選題：食管 + 良性狹窄　； 參考：《廣西醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：探討內(nèi)鏡治療小兒食管良性狹窄三種擴(kuò)張方式的療效及差異 方法：收集廣西醫(yī)科大學(xué)第一附屬醫(yī)院2001年1月至2011年11月2日24例小兒食管良性狹窄患者,通過胃鏡及上消化道鋇餐明確食管狹窄性質(zhì),部位及程度,對其進(jìn)行回顧性分析,24例患者均行內(nèi)鏡下球囊、水囊或探條擴(kuò)張術(shù),比較患者擴(kuò)張前后吞咽困難評分,胃鏡下狹窄直徑和擴(kuò)張次數(shù),進(jìn)行統(tǒng)計(jì)學(xué)分析比較,評價(jià)三種擴(kuò)張方式療效,并對其進(jìn)行隨訪。 結(jié)果：24例小兒食管良性狹窄患者,其中術(shù)后吻合口狹窄7例(29.17%),,化學(xué)燒傷后狹窄10例(41.67%),賁門失弛緩3例(12.5%),先天性食管狹窄3例(12.5%),腮腺術(shù)后損傷所致食管狹窄1例(4.17%)。共行76例次擴(kuò)張,其中最小年齡100天,最大年齡14歲,中位年齡為10.02歲,4例次因進(jìn)鏡后無法通過交換導(dǎo)絲而未能行擴(kuò)張,占總例次5.26%,9例次于擴(kuò)張后行APC燒灼(11.84%),1例于水囊擴(kuò)張1次,探條擴(kuò)張4次后放置食管CZES被膜支架,探條擴(kuò)張59例次(77.63%),,水囊擴(kuò)張6例次(7.89%),氣囊擴(kuò)張7例次(9.21%),2例次于探條擴(kuò)張后出現(xiàn)食管穿孔并轉(zhuǎn)外科手術(shù)治療(2.63%),3例次于X線透視下行探條擴(kuò)張術(shù),擴(kuò)張前狹窄段距門齒平均20.3±7.38cm,中位距離為18.3cm,擴(kuò)張前平均狹窄管徑0.48±0.21cm,中位管徑為0.45cm。探條、水囊、氣囊擴(kuò)張后狹窄處直徑均大于擴(kuò)張前(P0.05),擴(kuò)張后吞咽困難分級較擴(kuò)張前相比有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后2例次(2.63%)出現(xiàn)皮下氣腫,3例次(3.95%)出現(xiàn)發(fā)熱,經(jīng)治療后均好轉(zhuǎn)。探條組擴(kuò)張與氣囊、水囊組術(shù)后吞咽困難分級、狹窄處管徑比較無統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：食管術(shù)后吻合口狹窄,化學(xué)燒傷后狹窄,賁門失弛緩癥,先天性狹窄所致的小兒良性狹窄,內(nèi)鏡下擴(kuò)張為改善吞咽困難癥狀的有效方法,三組近期擴(kuò)張效果相比無明顯差別。術(shù)后食管穿孔為嚴(yán)重并發(fā)癥,術(shù)中觀察,及時(shí)術(shù)后影像學(xué)檢查有助于發(fā)現(xiàn)穿孔。
[Abstract]:Objective: To evaluate the efficacy and difference of endoscopic dilatation for three children with benign esophageal strictures.
Methods: 24 cases of benign esophageal stricture from January 2001 to November 2, 2011 were collected from the First Affiliated Hospital of Guangxi Medical University. The nature, location and degree of esophagus stenosis were analyzed by gastroscopy and upper gastrointestinal barium meal. 24 cases were treated with endoscopic balloon, water sac or sore dilation. Postoperative dysphagia score, narrowing diameter and dilation times under gastroscope were statistically analyzed and compared. The curative effects of three dilation methods were evaluated and followed up.
Results: 24 cases of benign esophageal stricture in children, including 7 cases of postoperative anastomotic stenosis (29.17%), 10 cases (41.67%), 3 cases of Cardia Achalasia (12.5%), 3 cases of congenital esophageal stenosis, 3 cases of congenital esophageal stenosis (12.5%), and 1 cases (4.17%) of esophagus stenosis caused by parotid surgery, among which the minimum age of 100 days, the maximum age of 14, and the middle The age was 10.02 years old, 4 cases failed to expand by exchanging guide wire after entering the mirror, accounting for 5.26%, 9 cases after expansion after APC cauterization (11.84%), 1 cases in the water sac expansion 1 times, the souch expansion 4 times after the placement of the esophageal stent, the expansion of the 59 times (77.63%), the balloon dilatation 6 times (7.89%), balloon dilatation 7 cases (9.21%) After the dilation of the strip, the esophagus perforation and transsurgical operation were found (2.63%), 3 after the X-ray dilatation, the average length of the narrow segment was 20.3 + 7.38cm, the median distance was 18.3cm, the average diameter of the narrow tube was 0.48 + 0.21cm, the median diameter was 0.45cm., the diameter of the water sac and the balloon dilation were all greater than that of the expansion. Before expansion (P0.05), the classification of dysphagia after dilation was statistically significant compared with that before expansion (P0.05). 2 cases (2.63%) had subcutaneous emphysema, 3 cases (3.95%) had fever and improved after treatment. The sore group dilated and balloon, the dysphagia was classified after the operation of the water sac group, and the diameter of the stenosis was not statistically significant (P0.05).
Conclusion: stricture of anastomotic stoma, postoperative stricture of chemical burn, achalasia of cardia, congenital stricture of children caused by congenital stenosis, endoscopic dilatation as an effective method to improve dysphagia symptoms, there is no significant difference between the three groups in the near future. Lookup helps to find perforation.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王正冬;金根培;周愛明;;腹腔鏡改良Heller手術(shù)治療賁門失弛緩癥(附七例報(bào)告)[J];第二軍醫(yī)大學(xué)學(xué)報(bào);2007年09期

2 朱立春;尹傳高;王昶;汪松;陳冰清;;球囊擴(kuò)張治療小兒上胃腸道狹窄[J];放射學(xué)實(shí)踐;2007年08期

3 趙海華,余永偉,王彥麗;原發(fā)性食管結(jié)核誤診為食管癌一例報(bào)告[J];第二軍醫(yī)大學(xué)學(xué)報(bào);2005年03期

4 趙志峰;麻樹人;張寧;楊卓;趙云峰;高飛;韓笑;高峰;宮照潔;楊琳;;小兒上消化道異物的內(nèi)鏡治療[J];解放軍醫(yī)學(xué)雜志;2009年11期

5 俞炬明;范國平;鐘偉興;朱銘;;暫時(shí)性食管支架成形術(shù)治療兒童食管良性狹窄[J];介入放射學(xué)雜志;2007年11期

6 穆林森,李延城;硬化法治療食管胃底靜脈曲張合并食管狹窄2例臨床分析[J];黑龍江醫(yī)藥科學(xué);2001年02期

7 張寅;許春娣;;兒童賁門失弛緩癥13例診治分析[J];臨床兒科雜志;2007年05期

8 郝晶,李旭,李心元;小兒食道化學(xué)性燒傷的緊急處理與狹窄治療[J];臨床小兒外科雜志;2003年03期

9 徐鵬飛;洪連造;柳紫薇;王麗鳳;;胃鏡直視下薩氏探條擴(kuò)張器擴(kuò)張治療食管良性狹窄[J];內(nèi)科急危重癥雜志;2008年01期

10 沈淳;鄭珊;呂志葆;肖現(xiàn)民;;胃鏡輔助下探條擴(kuò)張?jiān)谛菏车廓M窄中的應(yīng)用[J];臨床小兒外科雜志;2006年03期

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