Chen Tsung-Yi, Ko Sheung-Fat, Chuang Jiin-Haur, Kuo Hsin-Wei, Tiao Mao-Meng
Department of Pediatrics, Chang Gung Children's Hospital, Kaohsiung, Taiwan 833, ROC.
Chang Gung Med J. 2003 Apr;26(4):233-9.
Prediction of the severity of esophageal injury following ingestion of a caustic substance is a challenging problem for clinicians. It was hoped that risk factors for the early prediction of esophageal stricture in such patients could be identified in this study.
This study comprises an evaluation of 32 children with esophageal injury due to ingestion of caustic materials. Patients' signs and symptoms as well as laboratory data including leukocyte counts and C-reactive protein level were reviewed.
Patients who presented with a greater number of symptoms and signs were inclined to have more severe esophageal injury and stricture. The frequency of symptoms and signs in patients with serious esophageal injury was higher than that in patients with low-grade injury. Patients with severe injury were more significantly associated with the occurrence of stricture. The characteristic of caustic ingestion was associated with esophageal stricture, but not esophageal injury. There was no statistically significant difference in leukocyte counts relative to severity of esophageal injury. The mean of leukocyte counts of patients with esophageal stricture was close to that of patients without esophageal stricture. There was also no statistically significant difference in C-reactive protein values between the 2 groups of patients.
Leukocyte counts and C-reactive protein are not useful parameters for predicting the severity of esophageal injury and occurrence of stricture following injury to the esophagus by caustic materials. Alkali ingestion more probably leads to esophageal stricture than acid ingestion. After caustic ingestion, the presence of a greater number of symptoms and signs suggests a more-severe injury, which necessitates more-aggressive management.
对于临床医生而言，预测腐蚀性物质摄入后食管损伤的严重程度是一个具有挑战性的问题。本研究旨在确定此类患者食管狭窄早期预测的危险因素。
本研究对32例因摄入腐蚀性物质导致食管损伤的儿童进行了评估。回顾了患者的体征和症状以及包括白细胞计数和C反应蛋白水平在内的实验室数据。
出现更多症状和体征的患者往往食管损伤和狭窄更严重。严重食管损伤患者的症状和体征出现频率高于轻度损伤患者。严重损伤患者与狭窄的发生更显著相关。腐蚀性物质摄入的特征与食管狭窄有关，但与食管损伤无关。白细胞计数相对于食管损伤严重程度无统计学显著差异。食管狭窄患者的白细胞计数平均值与无食管狭窄患者相近。两组患者的C反应蛋白值也无统计学显著差异。
白细胞计数和C反应蛋白不是预测腐蚀性物质导致食管损伤严重程度及损伤后狭窄发生的有用参数。摄入碱性物质比摄入酸性物质更易导致食管狭窄。腐蚀性物质摄入后，出现更多症状和体征提示损伤更严重，需要更积极的治疗。
