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腐蚀性食管炎的治疗(作者译)

[The management of corrosive oesophagitis (author's transl)].

作者信息

Lallemant Y, Gehanno P, Flieder J, Barrier M, Martin M

出版信息

Ann Otolaryngol Chir Cervicofac. 1978 Jun;95(6):345-60.

PMID:742792
Abstract

Regardless of the treatment used against corrosive oesophagitis, the laryngologist must play a role from the beginning and throughout the course. The fibroblasts and collagen fibres which results are the natural agents of healing but, at the same time, are responsible for virtually inexorable stenosis if the corrosion has passed through to the muscular layers. Infection is constant and contributes to stenosis. The effectiveness of antibiotics is certain. They must be used from the beginning and continued for as long as necessary. As far as fibroiss is concerned, dilatations remain the basic treatment, their application requiring great experience and much patience and tenacity. Replacement surgery is attractive. It comes up against the stenosing perioesophageal inflammatory process which tends to die down in time but remains active for a long period. The nENT specialist must therefore pay careful attention from the very end of the postoperative period onwards. The gravity of oesophageal burns justifies intensification of preventive measures. Since it impossible to complete eliminate corrosive oesophagitis, efforts must be directed towards the discovery of substances capable of inhibiting collagen synthesis. Corticosteroids used in the treatment of shock do not prevent stenosis. In the laboratory, B.A.P.N. has shown its effectiveness in the rat. Also in the rat, particularly difficult experiments are in progress using penicillinamine. Although such methods have as yet to be extended to human clinical use, there are nevertheless grounds for hope.

摘要

无论采用何种治疗方法来对抗腐蚀性食管炎,耳鼻喉科医生都必须从一开始并在整个病程中发挥作用。成纤维细胞和胶原纤维是愈合的天然介质,但同时,如果腐蚀已穿透至肌层,它们实际上会导致不可避免的狭窄。感染持续存在并促成狭窄。抗生素的有效性是肯定的。必须从一开始就使用,并根据需要持续使用。就纤维化而言,扩张仍然是基本治疗方法,其应用需要丰富的经验、极大的耐心和坚韧不拔的精神。替代手术很有吸引力。它面临着食管周围炎性狭窄过程,该过程往往会随着时间的推移而逐渐消退,但会长期保持活跃。因此,耳鼻喉科专家必须从术后末期开始就密切关注。食管烧伤的严重性证明了加强预防措施的合理性。由于不可能完全消除腐蚀性食管炎,必须致力于发现能够抑制胶原合成的物质。用于治疗休克的皮质类固醇并不能预防狭窄。在实验室中,β-氨基丙腈在大鼠身上已显示出其有效性。同样在大鼠身上,使用青霉胺的特别困难的实验正在进行中。尽管这些方法尚未扩展到人类临床应用,但仍有希望的理由。

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