Benjamin B, Robb P, Glasson M
Ear, Nose and Throat Department, Royal Alexandra Hospital for Children, Sydney, Australia.
Ann Otol Rhinol Laryngol. 1993 May;102(5):332-6. doi: 10.1177/000348949310200502.
A retrospective review from 1981 to 1986 was made of 51 neonates who were treated for congenital esophageal atresia at the Royal Alexandra Hospital for Children, Sydney, Australia. Thirty of the 51 had primary repair and 15 (50%) developed esophageal stricture requiring one or more dilations. Stricture dilations were performed with open-tube rigid esophagoscopes, rigid telescopes, and Jackson dilators. The number of dilations performed until the patient was asymptomatic ranged from 1 to 12 (mean 4.5). The minimal follow-up time was 4 years. There was one esophageal perforation with full recovery following conservative management. One child died of septicemia caused by continued aspiration of unknown cause. A surprising finding, contrary to other reports, was the stricture formation did not appear to be related to the size of the "gap" found at the time of esophageal repair. Gastroesophageal reflux, however, was an important factor. We conclude that esophageal stricture following repair of tracheoesophageal atresia can be satisfactorily and relatively safely managed by direct vision antegrade endoscopic dilation using graduated dilators, although treatment may be prolonged and repeated. New esophagoscopes and dilators, in graduated sizes and designed for pediatric use, are recommended. The technique of esophageal dilation in infants is described in detail. Pediatric laryngobronchoesophagologists will become more involved in the care of infants born with esophageal atresia with or without tracheoesophageal fistula.
对1981年至1986年期间在澳大利亚悉尼皇家亚历山德拉儿童医院接受先天性食管闭锁治疗的51例新生儿进行了回顾性研究。51例中有30例行一期修复，其中15例（50%）出现食管狭窄，需要进行一次或多次扩张。采用开管硬式食管镜、硬式望远镜和杰克逊扩张器进行狭窄扩张。在患者无症状之前进行的扩张次数为1至12次（平均4.5次）。最短随访时间为4年。保守治疗后有1例食管穿孔完全恢复。1名儿童死于不明原因的持续误吸所致的败血症。与其他报告相反，一个惊人的发现是狭窄形成似乎与食管修复时发现的“间隙”大小无关。然而，胃食管反流是一个重要因素。我们得出结论，虽然治疗可能需要延长和重复，但通过使用分级扩张器的直视顺行内镜扩张可以令人满意且相对安全地处理气管食管闭锁修复术后的食管狭窄。推荐使用新的分级尺寸且专为儿科设计的食管镜和扩张器。详细描述了婴儿食管扩张技术。小儿喉气管食管科医生将更多地参与到患有或不患有气管食管瘘的食管闭锁患儿的护理中。
