Neilson I R, Croitoru D P, Guttman F M, Youssef S, Laberge J M
Montreal Children's Hospital, McGill University, Quebec, Canada.
J Pediatr Surg. 1991 Apr;26(4):478-81; discussion 481-2. doi: 10.1016/0022-3468(91)90999-a.
A series of six patients with congenital esophageal stenosis associated with esophageal atresia (EA) and distal tracheoesophageal fistula is presented. Three patients required only repeated dilatations, and have had good results. Two patients required limited resections of the distal esophagus, with excellent results. One patient died following a Heller myotomy. Tracheobronchial rests were present in the distal esophagus in the latter three patients. Diagnosis of congenital distal esophageal stenosis following repair of EA requires a high index of suspicion and a careful review of previous esophagrams. It is important to exclude anastomotic stricture and stenosis associated with gastroesophageal reflux. This requires barium esophagram, esophagoscopy with biopsy, and esophageal pH monitoring. Once a congenital basis for distal esophageal stenosis is suspected, management consists of dilatation by bouginage followed by balloon dilatation. Resection is reserved for persistent stenoses from tracheobronchial rests, which usually do not respond to dilatations.
本文介绍了一系列六例患有先天性食管狭窄并伴有食管闭锁（EA）和远端气管食管瘘的患者。三名患者仅需反复扩张，效果良好。两名患者需要对远端食管进行有限切除，效果极佳。一名患者在进行海勒肌切开术后死亡。后三名患者的远端食管存在气管支气管残余物。在EA修复术后诊断先天性远端食管狭窄需要高度的怀疑指数，并仔细回顾先前的食管造影。排除吻合口狭窄和与胃食管反流相关的狭窄很重要。这需要进行钡剂食管造影、食管镜检查及活检以及食管pH监测。一旦怀疑远端食管狭窄有先天性基础，治疗方法包括先用探条扩张，随后进行球囊扩张。手术切除仅适用于由气管支气管残余物导致的持续性狭窄，这种狭窄通常对扩张治疗无反应。
