Gastroenterology and Pediatric General Surgery Divisions, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada H3H1P3.
Dis Esophagus. 2013 May-Jun;26(4):382-7. doi: 10.1111/dote.12047.
Esophageal strictures remain the most frequent complication after esophageal atresia (EA) repair despite refinements in operative techniques. With an incidence of anastomotic stricture between 8% and 49%, EA is the most frequent cause of benign esophageal stricture in children. The mainstay of treatment for esophageal stricture is dilatation with a 58-96% success rate. In order to relieve dysphagia, between 1 and 15 dilatations will be required in each EA patient with an esophageal stricture. However dilatations may lead to complications including perforation (0.1-0.4% of all esophageal benign strictures) and sociopsychological morbidity. Fifty percent of EA strictures will improve in 6 months. However, 30% will persist and require repeat dilatations. The present article explores the variety of non-surgical alternative treatments for anastomotic strictures after EA repair, focusing on triamcinolone acetonide, mitomycin C and esophageal stents. We propose an algorithm for a more standardized therapeutic approach, with the hope that an international panel of experts could meet and establish a consensus.
尽管手术技术不断改进，但食管闭锁（EA）修复后食管狭窄仍然是最常见的并发症。吻合口狭窄的发生率为 8%至 49%，EA 是儿童良性食管狭窄最常见的原因。食管狭窄的主要治疗方法是扩张，成功率为 58%-96%。为了缓解吞咽困难，每个 EA 合并食管狭窄的患者需要进行 1 至 15 次扩张。然而，扩张可能会导致并发症，包括穿孔（所有良性食管狭窄的 0.1%-0.4%）和社会心理发病率。50%的 EA 狭窄会在 6 个月内改善。然而，30%的狭窄会持续存在并需要重复扩张。本文探讨了 EA 修复后吻合口狭窄的各种非手术替代治疗方法，重点介绍了曲安奈德、丝裂霉素 C 和食管支架。我们提出了一种更标准化治疗方法的算法，希望一个国际专家组能够开会并达成共识。
