Lamireau T, Llanas B, Deprez C, el Hammar F, Vergnes P, Demarquez J L, Favarel-Garrigues J C
Service d'urgences pédiatriques, CHU Pellegrin, Bordeaux, France.
Arch Pediatr. 1997 Jun;4(6):529-34. doi: 10.1016/s0929-693x(97)87571-9.
Caustic ingestion is frequent in children, sometimes leading to esophageal stricture.
Between 1988 and 1994, esogastroscopy was performed in 65 children after caustic ingestion. The children were classified in three groups: no lesion (group A), minimal lesions (group B) and severe lesions (group C). Nature of the caustic substance, clinical signs and evolution were compared in the three groups.
Median age was 2 years for the 65 children (24 girls, 41 boys). Ingestion occurred at home (94%) during meal periods. Substances were dishwater detergents (n = 14), oven cleaner (n = 10), bleach (n = 9), washing powder (n = 4), others (n = 20), more often in a liquid form (n = 37) than solid (n = 28). Children had no symptoms (57%), presented emesis (n = 20) or abdominal pain (n = 10) not correlated to endoscopic findings, and hematemesis (n = 3) or respiratory distress (n = 4), both symptoms seen only in group C. Buccal lesions (41%) were not correlated to endoscopic findings. After endoscopy, 28 children (43%) were classified into group A and 20 children (31%) in group B. Among the 17 children (26%) of the group C, eight developed an esophageal stricture: seven long strictures requiring replacement of the esophagus, one short stricture requiring repeated dilations.
Esophageal stricture is still a severe complication after caustic ingestion. These data stress the interest of controlled studies to confirm the preventive role of high dose corticosteroids, and the importance of the prevention of accidental caustic ingestions in children.
儿童腐蚀性物质摄入较为常见，有时会导致食管狭窄。
1988年至1994年间，对65例腐蚀性物质摄入后的儿童进行了食管胃镜检查。这些儿童被分为三组：无病变（A组）、轻度病变（B组）和重度病变（C组）。比较了三组中腐蚀性物质的性质、临床体征及病情演变。
65例儿童的中位年龄为2岁（24例女孩，41例男孩）。摄入多发生在家中（94%）且在进餐期间。腐蚀性物质包括餐具洗涤剂（n = 14）、炉灶清洁剂（n = 10）、漂白剂（n = 9）、洗衣粉（n = 4）、其他（n = 20），多为液体形式（n = 37）而非固体（n = 28）。儿童无症状（57%），出现呕吐（n = 20）或腹痛（n = 10），这些症状与内镜检查结果无关，还出现呕血（n = 3）或呼吸窘迫（n = 4），这两种症状仅在C组出现。口腔病变（41%）与内镜检查结果无关。内镜检查后，28例儿童（43%）被归入A组，20例儿童（31%）被归入B组。C组的17例儿童（26%）中，8例发生了食管狭窄：7例长段狭窄需要进行食管置换，1例短段狭窄需要反复扩张。
腐蚀性物质摄入后食管狭窄仍是一种严重并发症。这些数据强调了进行对照研究以证实高剂量皮质类固醇预防作用的意义，以及预防儿童意外腐蚀性物质摄入的重要性。
