Tannuri Ana Cristina Aoun, Tannuri Uenis
Pediatric Surgery Division, Pediatric Liver Transplantation Unit and Laboratory of Research in Pediatric Surgery (LIM 30), University of Sao Paulo Medical School, Sao Paulo, Brazil.
Pediatric Surgery Division, Pediatric Liver Transplantation Unit and Laboratory of Research in Pediatric Surgery (LIM 30), University of Sao Paulo Medical School, Sao Paulo, Brazil.
J Pediatr Surg. 2017 Nov;52(11):1742-1746. doi: 10.1016/j.jpedsurg.2017.02.003. Epub 2017 Feb 12.
BACKGROUND/PURPOSE: The treatment of children with esophageal strictures and involvement of the hypopharynx caused by caustic substance ingestion continues to be challenging. The aims of the present study are to describe the peculiarities of the technique of complete esophageal substitution for the treatment of children with severe caustic strictures (pharyngocoloplasties) and to compare the results to those of classical esophagocoloplasty with thoracic and abdominal esophageal substitution in another group of children.
A total of 258 children underwent colon interposition for esophageal replacement. Among these patients, 19 had complex esophageal caustic strictures involving the high level of the esophagus and hypopharynx without response to endoscopic dilatations. This group was compared with another group who required partial esophagocoloplasty with intact hypopharynx and high esophagus (239 patients). For the pharyngocoloplasty procedure, the transverse and great parts of the right colon were the segments selected for interposition and were maintained by a double vascular pedicle based on the left colic vessels and the marginal paracolic arcade via the sigmoid vessels.
In the pharyngocoloplasty group, 9 patients (47.4%) presented with cervical anastomosis stenosis with episodes of aspiration pneumonia, although good responses to endoscopic dilatation treatments were observed. All patients survived. In the esophagocoloplasty group, the main complications were cervical leaking (18.0%) and stenosis (16.7%). Statistical comparisons revealed that the pharyngocoloplasty patients exhibited a lower incidence of cervical leakage and increased incidences of cervical stenosis and aspiration pneumonia, although all patients could swallow normally.
Pharyngocoloplasty with complete esophageal substitution is a safe and effective procedure for the treatment of esophageal caustic strictures with severe stenoses reaching the hypopharynx that are refractory to previous endoscopic treatment.
II.
背景/目的：腐蚀性物质摄入导致的儿童食管狭窄并累及下咽的治疗仍然具有挑战性。本研究的目的是描述完全食管替代术治疗儿童严重腐蚀性狭窄（咽结肠成形术）的技术特点，并将结果与另一组接受胸腹段食管替代的经典食管结肠成形术的儿童进行比较。
共有258例儿童接受结肠代食管术。其中，19例患有复杂的食管腐蚀性狭窄，累及食管上段和下咽，内镜扩张治疗无效。将该组与另一组需要保留下咽和食管上段的部分食管结肠成形术的患者（239例）进行比较。对于咽结肠成形术，选择右半结肠的横部和大部作为代食管段，并通过基于左结肠血管和经乙状结肠血管的边缘结肠旁弓的双血管蒂进行保留。
在咽结肠成形术组中，9例患者（47.4%）出现颈部吻合口狭窄并伴有吸入性肺炎发作，尽管内镜扩张治疗效果良好。所有患者均存活。在食管结肠成形术组中，主要并发症为颈部渗漏（18.0%）和狭窄（16.7%）。统计比较显示，咽结肠成形术患者颈部渗漏发生率较低，颈部狭窄和吸入性肺炎发生率较高，尽管所有患者均可正常吞咽。
完全食管替代的咽结肠成形术是治疗食管腐蚀性狭窄伴严重狭窄累及下咽且对先前内镜治疗无效的安全有效方法。
II级。
