Brankov O
Khirurgiia (Sofiia). 2016;82(3):134-44.
The chemical burn of the esophagus and stomach, caused by concentrated acids or alkalis, is related to the development of a multitude of serious surgical complications and represents an actual social and medical problem.
Presentation of an algorithm of therapeutic measures in cases of corrosive burns of esophagus and stomach in children with the acute and chronic phase of the disease, developed on the grounds of our long-term clinical experience.
The studies and practical conclusions were based on out 36-year experience (from the year 1976 to 2012) in the treatment of 816 children with corrosive disease, treated at the Department of Pediatric Thoracic Surgery and the Department of Pediatric Toxicology of the General Hospital "N. I. Pirogov" -Sofia.
581 children (71.2%) in the acute phase of the corrosive intoxication were admitted for treatment. The rest 235 children (28.8%) were admitted for treatment in the late phase with formed fibrotic stricture of esophagus or stenosis of pylorus. Early diagnostic endoscopy was performed in 244 children (41.9 %). 83 children (34 %) had corrosive burn of 0-1 degree; 30 (13.3 %) -burn of 2-a grade; 123 (50 %) - burns of II-B and III grade; and 9 (3.7 %) - burn of 4 grade. Conservative treatment with bougienage was performed in 345 children (89.4 %). Esophageal replacement was performed in 81 children - colon was used in 57 of them, and whole stomach - in 24. Early surgical complications in the acute phase of the corrosive disease were observed in 99 children (25.1 %). Lethal outcome occurred in 9 children - colon was used in 57 of them, and whole stomach - in 24. Early surgical complications in the acute phase of the corrosive disease were observed in 99 children (25.1 %). Lethal outcome occurred in 9 children (2.4 %) died in the course of the conservative and surgical treatment.
The corrosive disease is a complex pathological process, which involves not only the upper digestive tract, but also the entire organism. The main burden during the course of disease falls over the surgical complications in the acute phase. The treatment of the late sequelae of the corrosive disease requires complex conservative and surgical approach, which on its turn requires availability of a sophisticated multidisciplinary medical team.
由浓酸或强碱引起的食管和胃部化学灼伤，与多种严重手术并发症的发生相关，是一个现实的社会和医学问题。
基于我们长期的临床经验，介绍针对儿童食管和胃部腐蚀性灼伤急性期和慢性期的治疗措施算法。
研究和实践结论基于我们36年（从1976年至2012年）在“N. I. 皮罗戈夫”综合医院 - 索菲亚儿科胸外科和儿科毒理学部治疗816例腐蚀性疾病患儿的经验。
581例（71.2%）处于腐蚀性中毒急性期的患儿入院接受治疗。其余235例（28.8%）患儿在后期因形成食管纤维化狭窄或幽门狭窄入院治疗。244例（41.9%）患儿进行了早期诊断性内镜检查。83例（34%）患儿为0 - 1度腐蚀性灼伤；30例（13.3%）为2 - a级灼伤；123例（50%）为II - B级和III级灼伤；9例（3.7%）为4级灼伤。345例（89.4%）患儿接受了扩张治疗的保守治疗。81例患儿进行了食管置换 - 其中57例采用结肠，24例采用全胃。在腐蚀性疾病急性期观察到99例（25.1%）患儿出现早期手术并发症。9例患儿死亡 - 其中57例采用结肠，24例采用全胃。在腐蚀性疾病急性期观察到99例（25.1%）患儿出现早期手术并发症。9例（2.4%）患儿在保守和手术治疗过程中死亡。
腐蚀性疾病是一个复杂的病理过程，不仅累及上消化道，还涉及整个机体。疾病过程中的主要负担落在急性期的手术并发症上。腐蚀性疾病后期后遗症的治疗需要综合的保守和手术方法，这反过来需要有一个复杂的多学科医疗团队。
