Okada T, Ohnuma N, Tanabe M, Iwai J, Yoshida H, Kuroda H, Takahashi H
Department of Pediatric Surgery, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260, Japan.
Pediatr Surg Int. 1998 Sep;13(7):480-6. doi: 10.1007/s003830050378.
The authors present a safe, conservative method of endless-loop bougienage (ELB) through the oral cavity and esophagus to a gastrostomy without general anesthesia in three children with corrosive esophageal burns treated since 1966. Esophagogastroscopy was performed to evaluate for esophagitis at an early phase after ingestion of the caustic substance. When esophageal stricture formation was recognized after subsequent conservative treatment, a feeding gastrostomy was made. A continuous string loop with plummets of progressively larger size was positioned to pass through the patient's oral cavity and esophagus to the gastrostomy. Strictures were found in the upper esophagus in two patients and in the middle and lower esophagus in one. The gastrostomy was performed 15 months, 20 days, and 2 months after the injury, respectively, and the periods of ELB were 3, 5, and 2(1/2) years, respectively. The patients were able to start eating at 26, 42, and 29 months after injury, respectively. They are now 30, 18, and 17 years old, and slight dysphagia remains in patients 1 and 2. No patient developed esophageal carcinoma at the site of the corrosive stricture. Our method of ELB through the patient's oral cavity and esophagus to the gastrostomy appears to be safe, reliable, and useful. We believe that most caustic esophageal strictures in children can be treated by this conservative measure.
自1966年以来，作者采用一种安全、保守的方法，即通过口腔和食管进行无间断探条扩张术（ELB）至胃造口术，对3例腐蚀性食管烧伤患儿进行治疗，无需全身麻醉。在摄入腐蚀性物质后的早期阶段，进行食管胃镜检查以评估食管炎情况。在后续保守治疗后发现食管狭窄形成时，行胃造口术。将带有逐渐增大的坠子的连续绳圈经患者口腔和食管置入胃造口处。2例患者食管狭窄位于食管上段，1例位于食管中下段。胃造口术分别在受伤后15个月、20天和2个月进行，ELB持续时间分别为3年、5年和2（1/2）年。患者分别在受伤后26个月、42个月和29个月开始进食。他们现在分别为30岁、18岁和17岁，第1例和第2例患者仍有轻微吞咽困难。在腐蚀性狭窄部位，无患者发生食管癌。我们通过患者口腔和食管至胃造口术的ELB方法似乎是安全、可靠且有用的。我们认为，大多数儿童腐蚀性食管狭窄可通过这种保守措施进行治疗。
