Asensio Llorente M, Broto Mangues J, Gil-Vernet Huguet J M, Acosta Farina D, Marhuenda Irastorza C, Boix-Ochoa J
Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona.
Cir Pediatr. 1999 Jan;12(1):33-7.
Dilatations are considered the election treatment for esophageal stenosis of different etiologies. Different methods of dilatation have been used through the years. Security and effectiveness are the main subjects when we choose a dilatation method. We present the results of the last 3 years that Savary-Guilliard have been used, with a guide wire probe, under endoscopic control. Six patients with postsurgical stenosis and 10 with post lye ingestion stenosis were treated with the above mentioned method. The site of stenosis is localized under flexible endoscopy, and a special guide wire probe is introduced to the stomach. Once the wire is in place, different diameter bougies are introduced until a firm resistance is felt or the desired diameter is reach. In complicated cases the progression of the wire was controlled by X-rays. A total of 208 dilatations have done in 16 patients over the last three years. Six patients with postsurgical stenosis needed from two to six dilatations for their cure. Of the 10 patients who ingest lye, none of them had needed a gastrostomy. Three of them have no dysphagia after 9, 13 and 13 dilatations. The other 7 are under dilatations every 6 weeks in 6 cases and every 4 weeks in one case, been all of them in the second year of treatment. All the dilatations have been performed under general anesthesia, as outpatients. We have not had any complication under this treatment. We have found that the Savary-Guilliard method is adequate for esophageal dilatations in pediatric population. Security and effectiveness are the main points of this procedure, there is no need for a gastrostomy, and the child will have a better quality of life. This procedure is less aggressive, and this will give a shorter postop period, with no complications and the child will have a longer period of normal life between dilatations.
扩张术被认为是治疗不同病因所致食管狭窄的首选方法。多年来已采用了不同的扩张方法。我们在选择扩张方法时，安全性和有效性是主要考量因素。我们呈现过去3年使用Savary - Guilliard探条并在导丝引导下、在内镜控制下进行治疗的结果。6例术后狭窄患者和10例误服碱液后狭窄患者接受了上述方法治疗。在可弯曲内镜下确定狭窄部位，将特制导丝探条插入胃内。导丝到位后，依次插入不同直径的探条，直至感觉到明显阻力或达到所需直径。在复杂病例中，通过X线控制导丝的推进。在过去三年中，16例患者共进行了208次扩张术。6例术后狭窄患者治愈需要进行2至6次扩张术。在10例误服碱液的患者中，无人需要进行胃造口术。其中3例患者分别在接受9次、13次和13次扩张术后无吞咽困难。另外7例患者在治疗的第二年，6例每6周进行一次扩张术，1例每4周进行一次扩张术。所有扩张术均在全身麻醉下作为门诊手术进行。在这种治疗方法下我们未出现任何并发症。我们发现Savary - Guilliard方法适用于儿科患者的食管扩张术。安全性和有效性是该手术的要点，无需进行胃造口术，患儿生活质量会更好。该手术创伤较小，术后恢复时间较短，无并发症，且患儿在两次扩张术之间有较长时间的正常生活。
