Defagó Victor, Moyano Jimena, Bernhardt Celina, Sambuelli Gabriela, Cuestas Eduardo
Department of Pediatric Surgery, Faculty of Medical Sciences, National University of Cordoba, Cordoba, Argentina.
Department of Pathology, Faculty of Medicine, Catholic University of Cordoba, Cordoba, Argentina.
J Pediatr Surg. 2015 Aug;50(8):1264-8. doi: 10.1016/j.jpedsurg.2014.11.040. Epub 2014 Nov 28.
The ingestion of caustic substances remains an important public health issue worldwide. Children represent 80% of the ingestion injury population globally. Accidental alkaline material accounts for most caustic ingestions. There is no conclusive evidence of tissue damage and stricture protection of a nasogastric-tube with a solid dilator in the literature, therefore it was hypothesized that early intraesophageal tube placement does not cause additional histopathologic damage and prevents strictures.
An exploratory study on experimental caustic esophageal burns in a rabbit model was designed. In the treated group a silicone tube was placed immediately after causing the burns, while the untreated group followed the natural course of the burn. On the twenty-secondday, an esophagectomy was performed on all animals for microscopic (Histopathologic Damage Score and Stenosis Index) and macroscopic analysis.
Forty animals were randomly divided into two groups. The Histopathologic Damage Score was 3.7±1.1 in the treated group versus 3.9±1.2 in the untreated group (p=.9690). The Stenosis Index was 0.6±0.1 in treated rabbits versus 2.3±0.2 in untreated (p<.0001).
The early placement of an intraesophageal tube with solid dilator prevents stenosis formation and does not produce greater tissue damage.
腐蚀性物质的摄入仍是全球范围内一个重要的公共卫生问题。儿童占全球摄入性损伤人群的80%。大多数腐蚀性物质摄入是由意外接触碱性物质所致。文献中尚无确凿证据表明使用固体扩张器的鼻胃管对组织损伤和狭窄有保护作用，因此推测早期放置食管内导管不会造成额外的组织病理学损伤并可预防狭窄。
设计了一项关于兔实验性腐蚀性食管烧伤的探索性研究。在治疗组中，烧伤后立即放置硅胶管，而未治疗组则任其烧伤自然发展。在第22天，对所有动物进行食管切除术以进行微观（组织病理学损伤评分和狭窄指数）和宏观分析。
40只动物被随机分为两组。治疗组的组织病理学损伤评分为3.7±1.1，而未治疗组为3.9±1.2（p = 0.9690）。治疗组兔的狭窄指数为0.6±0.1，未治疗组为2.3±0.2（p<0.0001）。
早期放置带有固体扩张器的食管内导管可预防狭窄形成，且不会造成更严重的组织损伤。
