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腐蚀性食管烧伤后经剖腹术行腔内支架置入预防狭窄

Prevention of stricture with intraluminal stenting through laparotomy after corrosive esophageal burns.

作者信息

Wang Ru-Wen, Zhou Jing-Hai, Jiang Yao-Guang, Fan Shi-Zhi, Gong Tai-Qian, Zhao Yun-Ping, Tan Qun-You, Lin Yi-Dan

机构信息

Department of Thoracic Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, PR China.

出版信息

Eur J Cardiothorac Surg. 2006 Aug;30(2):207-11. doi: 10.1016/j.ejcts.2006.03.068. Epub 2006 Jul 7.

Abstract

OBJECTIVE

We sought to present our experience in preventing esophageal stricture formation using modified intraluminal stenting in patients with caustic burns.

METHODS

Between April 1976 and June 2005, 33 of 162 patients with corrosive esophageal burns were included in this study. Endoscopy was performed to define the degree of injury in all the patients but one. Among the 33 patients, 31 underwent modified esophageal intraluminal stenting through laparotomy 2-3 weeks after ingestion of corrosive agent and the remaining 2 patients underwent immediately after experiencing esophageal perforation.

RESULTS

There was no death in this series. A 1-year-old child had aspiratory pneumonia because of poor compliance. The stent was removed without requiring anesthesia after it had been in situ for 4-6 months in the 33 patients. All the patients had a normal intake of food after removal of the stents, and stricture was not found on barium swallow. However, five patients had esophageal stenosis from 2 to 3 months during follow-up. One of them responded to esophageal bougienage, the remaining four patients required esophageal reconstruction and had a normal diet postoperatively. Twenty-four-hour pH monitoring in five patients showed that there was no gastroesophageal reflux.

CONCLUSION

The modified esophageal intraluminal stent is able to prevent the formation of caustic esophageal stricture.

摘要

目的

我们试图介绍在腐蚀性烧伤患者中使用改良腔内支架预防食管狭窄形成的经验。

方法

在1976年4月至2005年6月期间,162例腐蚀性食管烧伤患者中的33例被纳入本研究。除1例患者外,对所有患者均进行了内镜检查以确定损伤程度。在这33例患者中,31例在摄入腐蚀性物质后2至3周通过剖腹手术进行了改良食管腔内支架置入,其余2例在发生食管穿孔后立即进行了置入。

结果

本系列中无死亡病例。一名1岁儿童因依从性差患吸入性肺炎。在33例患者中,支架原位放置4至6个月后,无需麻醉即可取出。所有患者在取出支架后饮食正常,吞钡检查未发现狭窄。然而,5例患者在随访期间2至3个月出现食管狭窄。其中1例对食管扩张治疗有反应,其余4例患者需要进行食管重建,术后饮食正常。5例患者的24小时pH监测显示无胃食管反流。

结论

改良食管腔内支架能够预防腐蚀性食管狭窄的形成。

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