Anderson K D, Rouse T M, Randolph J G
Department of Surgery, Children's National Medical Center, Washington, DC 20010.
N Engl J Med. 1990 Sep 6;323(10):637-40. doi: 10.1056/NEJM199009063231004.
It is controversial whether treatment with corticosteroids reduces stricture formation in the esophagus after the ingestion of caustic material.
We conducted a prospective study over an 18-year period in which 60 children (median age, 2 years) with esophageal injury from the ingestion of caustic material were assigned randomly to treatment either with or without corticosteroids. The corticosteroids were given initially as prednisolon (2 mg per kilogram of body weight per day intravenously) and then as prednisone orally to complete a three-week course. All patients were evaluated by esophagoscopy within 24 hours of the ingestion. Those with moderate or severe esophageal injury had repeat esophagoscopy and barium swallow at follow-up.
Esophageal strictures developed in 10 of the 31 children treated with corticosteroids and in 11 of the 29 controls (P not significant). Four children in the steroid group and seven in the control group eventually required esophageal replacement (P not significant). All but 1 of the 21 children with strictures had severe circumferential burns on initial esophagoscopy.
There appears to be no benefit from the use of steroids to treat children who have ingested a caustic substance. The development of esophageal stricture was related only to the severity of the corrosive injury.
摄入腐蚀性物质后，使用皮质类固醇治疗是否能减少食管狭窄形成存在争议。
我们进行了一项为期18年的前瞻性研究，将60名因摄入腐蚀性物质导致食管损伤的儿童（中位年龄2岁）随机分为接受或不接受皮质类固醇治疗两组。皮质类固醇最初以泼尼松龙（每天每公斤体重2毫克静脉注射）给药，然后口服泼尼松以完成为期三周的疗程。所有患者在摄入后24小时内接受食管镜检查。中度或重度食管损伤患者在随访时进行重复食管镜检查和吞钡检查。
接受皮质类固醇治疗的31名儿童中有10名发生食管狭窄，29名对照组儿童中有11名发生食管狭窄（P无统计学意义）。类固醇组4名儿童和对照组7名儿童最终需要进行食管置换（P无统计学意义）。21名有狭窄的儿童中，除1名外，其余在初次食管镜检查时均有严重的环形烧伤。
对于摄入腐蚀性物质的儿童，使用类固醇治疗似乎没有益处。食管狭窄的发生仅与腐蚀性损伤的严重程度有关。
