儿童食管良性狭窄的超声内镜特征分析

Endoscopic ultrasonography features of benign esophageal stenosis in children

摘要:

目的 分析儿童食管良性狭窄的超声内镜（endoscopic ultrasonography, EUS）特征。方法 回顾性收集2019年2月—2022年2月诊断为食管良性狭窄患儿的临床资料，分析临床表现、EUS结果及治疗结局，总结儿童食管良性狭窄EUS特征。结果 共纳入42例食管良性狭窄患儿，其中19例（45%）为食管闭锁术后吻合口狭窄，EUS示食管管壁层次分界模糊，环狭窄口周围管壁厚度不均，内镜下治疗次数0~12次（平均2.1次）；5例（12%）腐蚀性食管狭窄及1例（2%）物理性食管狭窄，EUS示狭窄部未见明确管壁分层，内镜下治疗次数2~9次（平均5.3次）；1例（2%）EUS示环食管壁见斑片状不规则低回声，结合病理学检查结果确诊为气管软骨食管异位症；不明原因食管狭窄16例（38%），EUS示食管管壁层次分界不清，6例行内镜下治疗。随访过程中绝大部分（95%，40/42）患儿呕吐、吞咽困难等症状明显减轻。结论 对于儿童食管良性狭窄，EUS有助于判断食管狭窄病变管壁受累程度、可能的病因及病变处食管毗邻关系，为下一步治疗方式的选择及避免不必要的并发症提供依据，从而优化治疗方案。

Abstract:

Objective To investigate the endoscopic ultrasonography (EUS) features of benign esophageal stenosis in children.Methods A retrospective analysis was conducted on the medical data of the children who were diagnosed with benign esophageal stenosis from February 2019 to February 2022. The clinical manifestations, EUS findings, and treatment outcome were analyzed to summarize the EUS features of benign esophageal stenosis in children.Results A total of 42 children with benign esophageal stenosis were included. Among these children, 19 (45%) had anastomotic stenosis after surgery for esophageal atresia, with unclear echogenic boundary of the esophageal walls and uneven thicknesses of the surrounding wall on EUS, and had 0-12 sessions of endoscopic treatment (average 2.1 sessions); 5 children (12%) had corrosive esophageal stenosis and 1 child (2%) had physical esophageal stenosis, with unclear stratification of the esophageal walls on EUS, and they had 2-9 sessions of endoscopic treatment (average 5.3 sessions); 1 child (2%) had patchy irregular hypoechoic areas of the esophageal walls on EUS and was diagnosed with tracheobronchial remnants with reference to pathology; 16 children (38%) had unexplained esophageal stenosis and unclear stratification of the esophageal walls on EUS, among whom 6 received endoscopic treatment. During follow-up, 95% (40/42) of the children had significant alleviation of the symptoms such as vomiting and dysphagia.Conclusions For benign esophageal stenosis in children, EUS can help to evaluate the degree of esophageal wall involvement in esophageal stenosis lesions, possible etiologies, and the relationship between the esophagus and the lesion and provide an important basis for selecting treatment modality and avoiding complications, thereby helping to optimize the treatment regimen.