Othersen H B, Parker E F, Smith C D
Division of Pediatric Surgery, Medical University of South Carolina, Charleston 29425.
Ann Surg. 1988 May;207(5):590-7. doi: 10.1097/00000658-198805000-00013.
Early in this century all procedures performed on the esophagus were accomplished through its lumen. Ingestion of caustics was common and resulted in dense strictures for which complicated and ingenious methods of dilation were advised. Because obstructions usually recurred, by-pass operations were devised with conduits of skin or segments of the gastrointestinal tract. Now, in contrast, when burns occur, intensive steroid therapy usually prevents all but localized areas of stricture. These areas, if short, can be treated with hydrostatic balloon dilation under fluoroscopic control. If longer or resistant to dilation, these strictures can be managed by incision and insertion of a colic patch with excellent long-term results. To a previous series of children who have had esophageal patch with a vascularized segment of colon, now added is an experience with a free segment of small intestine with vascular anastomosis to an artery and vein in the neck and another case of a free patch of pericardium to the esophageal stricture.
本世纪初，所有针对食管的手术都是通过食管腔来完成的。腐蚀性物质的摄入很常见，会导致严重的狭窄，为此人们建议采用复杂而巧妙的扩张方法。由于梗阻通常会复发，于是设计了用皮肤管道或胃肠道段进行的旁路手术。相比之下，现在当发生烧伤时，强化类固醇疗法通常能防止除局部狭窄区域外的所有狭窄。这些短的狭窄区域可在荧光镜控制下用液压球囊扩张治疗。如果狭窄区域较长或对扩张有抵抗性，这些狭窄可通过切开并插入结肠补片来处理，长期效果良好。在之前一系列接受带血管化结肠段食管补片手术的儿童中，现在又增加了一例采用游离小肠段与颈部动静脉进行血管吻合的经验，以及另一例用游离心包补片治疗食管狭窄的病例。
