Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil.
J Laparoendosc Adv Surg Tech A. 2021 Dec;31(12):1445-1448. doi: 10.1089/lap.2021.0356. Epub 2021 Nov 5.
Congenital esophageal stenosis (CES) is a very rare clinical condition found in 1 per 25,000 to 50,000 live births. There are three histological types of CES described: tracheobronchial remnants, fibromuscular stenosis (FMS), and membranous stenosis. The first-line treatment in most cases is the conservative treatment (dilatation with a Savary bougie or balloon), but in some CES types, dilatation may be ineffective or result in esophageal perforation with serious complications or lethal outcome. Resection of the stenotic segment and end-to-end esophageal anastomosis was formerly presented as the most common surgical treatment option for CES. However, esophagoplasty is a safe and feasible alternative for surgical treatment of esophageal stenosis in children. Our aim is to report two cases of FMS submitted to thoracoscopic esophagoplasty. Both cases started with dysphagia and refusal after transition to solid diet, at 6 months old, and the radiological examination showed stricture of the distal esophagus. Esophagoplasty was performed with the patients in prone position. The stenotic esophageal wall was incised longitudinally and transverse synthesis was performed. After surgery, the patients had prompt recovery, without recurrent stenosis, remaining asymptomatic, with good diet acceptance.
先天性食管狭窄（CES）是一种非常罕见的临床病症，每 25000 至 50000 例活产中会出现一例。CES 有三种组织学类型：气管支气管残余物、纤维肌肉性狭窄（FMS）和膜性狭窄。大多数情况下的一线治疗是保守治疗（用 Savary 探条或球囊扩张），但在某些 CES 类型中，扩张可能无效或导致严重并发症或致命后果的食管穿孔。切除狭窄段并进行端端食管吻合术曾是 CES 的最常见手术治疗选择。然而，食管成形术是儿童食管狭窄的一种安全可行的手术治疗替代方法。我们的目的是报告两例接受胸腔镜食管成形术的 FMS 病例。这两例均在 6 个月大时开始出现固体饮食后吞咽困难和拒绝，放射学检查显示下段食管狭窄。手术时患者取俯卧位。狭窄的食管壁被纵向切开，并进行横向缝合。手术后，患者迅速恢复，无再狭窄，无症状，饮食接受良好。
