切换至 "中华医学电子期刊资源库"
高级检索
中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2022, Vol. 12 ›› Issue (02) : 76 -81. doi: 10.3877/cma.j.issn.2095-2015.2022.02.003

论著

超声内镜检查在儿童上消化道狭窄诊断与治疗中的应用价值
唐运萍1, 杨露1, 薛宁1, 李华1, 魏绪霞1, 徐俊杰1,†()   
  1. 1. 250022　济南，山东大学附属儿童医院消化科；250022　济南，山东省儿童健康与疾病临床医学研究中心
  • 收稿日期:2021-07-19 出版日期:2022-04-01
  • 通信作者: 徐俊杰

Application value of endoscopic ultrasound in diagnosis and treatment of upper gastrointestinal stenosis in children

Yunping Tang1, Lu Yang1, Ning Xue1, Hua Li1, Xuxia Wei1, Junjie Xu1,†()   

  1. 1. Department of Gastroenterology, Children's Hospital Affiliated to Shandong University, Jinan 250022, China; Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan 250022, China
  • Received:2021-07-19 Published:2022-04-01
  • Corresponding author: Junjie Xu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

唐运萍, 杨露, 薛宁, 李华, 魏绪霞, 徐俊杰. 超声内镜检查在儿童上消化道狭窄诊断与治疗中的应用价值[J]. 中华消化病与影像杂志(电子版), 2022, 12(02): 76-81.

Yunping Tang, Lu Yang, Ning Xue, Hua Li, Xuxia Wei, Junjie Xu. Application value of endoscopic ultrasound in diagnosis and treatment of upper gastrointestinal stenosis in children[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(02): 76-81.

目的

探讨超声内镜检查在儿童上消化道狭窄诊断与治疗中的应用价值。

方法

回顾性分析2015年5月至2020年5月山东大学附属儿童医院收治的上消化道狭窄患儿48例，包括食管狭窄27例（其中食管闭锁术后吻合口狭窄18例，化学腐蚀性食管狭窄3例，异物所致食管狭窄1例，病因不明食管狭窄5例），贲门失弛缓症4例，胃输出端狭窄12例，十二指肠狭窄5例。所有患儿均在麻醉状态下行超声内镜检查进行术前评估，根据上消化道狭窄部位、狭窄口大小及超声内镜下改变，选择不同的治疗方案。

结果

18例食管闭锁术后吻合口狭窄患儿超声内镜显示食管管壁层次分界不清，环狭窄口周围管壁厚度不均；3例腐蚀性食管损伤患儿超声内镜显示食管损伤程度不一；异物所致食管狭窄1例患儿超声内镜显示异物回声；病因不明食管狭窄5例患儿超声内镜示管壁层次分界不清。贲门失弛缓症4例患儿超声内镜显示贲门固有肌层厚度为0.9~4.0 mm。胃输出端狭窄12例患儿超声内镜显示狭窄部位层次不清、厚薄不均。十二指肠狭窄5例患儿中，4例为先天性发育异常，超声内镜显示狭窄部位局部组织呈均匀回声；1例为消化性溃疡所致十二指肠狭窄，超声内镜显示幽门黏膜隆起处管壁层次模糊。

结论

超声内镜检查可以明确儿童上消化道狭窄病变的起源及层次，有助于诊断和术前风险的评估，并为治疗方案的选择提供重要依据。

关键词: 上消化道狭窄, 儿童, 超声内镜检查, 诊断, 治疗
Objective

To evaluate the application value of endoscopic ultrasound in the diagnosis and treatment of upper gastrointestinal stenosis in children.

Methods

A total of 48 children with upper gastrointestinal stenosis admitted to Children's Hospital Affiliated to Shandong University from May 2015 to May 2020 were analyzed retrospectively. There were 27 cases of esophageal stricture (18 cases of anastomotic stricture after surgical correction of esophageal atresia, 3 cases of chemically corrosive stricture, 1 case of esophageal stricture caused by foreign body, 5 cases of esophageal stricture of unknown etiology), 4 cases of achalasia, 12 cases of gastric output stricture, and 5 cases of duodenal stricture. All the children were evaluated by endoscopic ultrasonography before surgery under anesthesia, and different treatment plans were selected according to the stenosis site of upper gastrointestinal tract, stenosis opening size and endoscopic ultrasonography changes.

Results

Endoscopic ultrasonography showed that the boundary of esophageal wall layer was not clear, and the thickness of the wall around the annular stenosis was uneven in 18 children with anastomotic stricture after surgical correction of esophageal atresia. Endoscopic ultrasonography showed different degree of esophageal injury in 3 children with corrosive esophageal injury. Endoscopic ultrasonography showed echo of foreign body in 1 child with esophageal stenosis caused by foreign body. Endoscopic ultrasonography showed unclear stratification of esophageal wall in 5 children with unexplained esophageal stenosis. Endoscopic ultrasonography showed that the thickness of cardia proper muscle layer was 0.9-4.0 mm in 4 children with achalasia. Endoscopic ultrasonography showed that the level of stenosis was not clear and the thickness was uneven in 12 children with gastric output stenosis. Among the 5 cases of duodenal stenosis, 4 cases of congenital dysplasia showed homogeneous echo in local tissues at the stenosis site by endoscopic ultrasonography, the other case was duodenal stricture caused by peptic ulcer, and endoscopic ultrasonography showed that the pyloric mucosa eminence was blurred.

Conclusion

Endoscopic ultrasound can accurately discover the origin and level of upper gastrointestinal stenosis in children, contribute to diagnosis and preoperative risk assessment, and provide an important basis for the selection of treatment plan.

Key words: Upper gastrointestinal stenosis, Child, Endoscopic ultrasonogaphy, Diagnosis, Treatment
图1 上消化道狭窄胃镜及超声内镜表现。A：图A1为胃镜显示食管狭窄；图A2为超声内镜提示食管管壁层次回声、环狭窄口周围管壁厚度不均；图A3为治疗后复查上消化道造影显示食管狭窄明显好转。B：图B1为胃镜显示食管狭窄；图B2为超声内镜显示食管管壁各层次分界不清，环管壁见斑片状不规则低回声；图B3为组织病理学检查显示可见呼吸道纤毛柱状上皮和腺体，并见软骨组织（HE，×200）。C：图C1为胃镜显示贲门失弛缓症；图C2为超声内镜显示食管层次清楚，以肌层最为显著；图C3为治疗后复查上消化道造影显示贲门口扩大。D：图D1为超声检查显示幽门肌层厚3.4~4.1 mm；图D2为胃镜显示先天性肥厚性幽门狭窄；图D3为超声内镜显示幽门肌层明显增厚，肌层增厚4.1~5.2 mm。E：图E1为胃镜显示胃输出端狭窄；图E2为超声内镜显示黏膜和黏膜下分层不清，局部黏膜增厚，肌层无增厚；图E3为治疗后复查上消化道造影显示造影剂通过幽门顺利，幽门管略细。F：图F1为胃镜显示十二指肠膜状狭窄；图F2为超声内镜显示狭窄口肠壁固有肌层连续完整，狭窄口局部膜状组织呈均匀回声，未见肠管壁层次回声；图F3为治疗后复查上消化道造影显示十二指肠水平段造影剂通过顺利，其以下肠管可见造影剂充盈
1
杨英,陈炳芳,丁炎波,等.微探头超声联合内镜超声在不明原因食管狭窄性病变诊治中的应用[J].中华消化内镜杂志, 2017, 34(10): 740-742.
2
潘骏,李兆申.超声内镜相关经自然腔道内镜手术的临床应用进展[J].中华消化杂志, 2018, 38(2): 139-141.
3
Wang J, Zhao L, Wu R, et al. Appropriate duration of endoscopic dilation for postoperative benign esophageal strictures [J]. Surg Endosc, 2022, 36(2): 1263-1268.
4
van der Zee D, Hulsker C. Indwelling esophageal balloon catheter for benign esophageal stenosis in infants and children [J]. Surg Endosc, 2014, 28(4): 1126-1130.
5
Akarsu C, Unsal MG, Dural AC, et al. Endoscopic balloon dilatation as an effective treatment for lower and upper benign gastrointestinal system anastomotic stenosis [J]. Surg Laparosc Endosc Percutan Tech, 2015, 25(2): 138-142.
6
Boregowda U, Goyal H, Mann R, et al. Endoscopic management of benign recalcitrant esophageal strictures [J]. Ann Gastroenterol, 2021, 34(3): 287-299.
7
胡亦懿,杜国平,李国华,等.内镜超声引导下反向切开术治疗食管良性难治性狭窄的初步应用[J].中华消化内镜杂志, 2020, 37(8): 558-561.
8
Mizusawa T, Kobayashi M, Terai S. Radial incision and cutting for refractory benign esophageal stricture [J]. Dig Endosc, 2019, 31(2): e46-e47.
9
徐俊杰,朱立平,张乐.儿童食管狭窄的内镜治疗[J].中国实用儿科杂志, 2018, 33(11): 840-845.
10
Yasuda JL, Staffa SJ, Clark SJ, et al. Endoscopic incisional therapy and other novel strategies for effective treatment of congenital esophageal stenosis [J]. J Pediatr Surg, 2020, 55(11): 2342-2347.
11
Mochizuki K, Shinkai M, Kitagawa N, et al. Laparoscopic partial circular myectomy for congenital esophageal stenosis due to tracheobronchial remnant [J]. Asian J Endosc Surg, 2020, 13(4): 592-595.
12
Kılıç ŞS, Serdar İskit H. Management and clinical outcomes of congenital esophageal stenosis in pediatric patients: Experience of a tertiary referral center [J]. J Pediatr Surg, 2022, 57(3): 518-525.
13
Zhong C, Tan S, Huang S, et al. Clinical outcomes of peroral endoscopic myotomy for achalasia in children: a systematic review and meta-analysis [J]. Dis Esophagus, 2021, 34(4): doaa112.
14
Nabi Z, Ramchandani M, Chavan R, et al. Outcome of peroral endoscopic myotomy in children with achalasia [J]. Surg Endosc, 2019, 33(11): 3656-3664.
15
Li SW, Tseng PH, Chen CC, et al. Muscular thickness of lower esophageal sphincter and therapeutic outcomes in achalasia: A prospective study using high-frequency endoscopic ultrasound [J]. J Gastroenterol Hepatol, 2018, 33(1): 240-248.
16
Wood LS, Chandler JM, Portelli KE, et al. Treating children with achalasia using per-oral endoscopic myotomy (POEM): Twenty-one cases in review [J]. J Pediatr Surg, 2020, 55(6): 1006-1012.
17
Krishnan K, Lin CY, Keswani R, et al. Endoscopic ultrasound as an adjunctive evaluation in patients with esophageal motor disorders subtyped by high-resolution manometry [J]. Neurogastroenterol Motil, 2014, 26(8): 1172-1178.
18
Morris G, Kennedy A Jr, Cochran W. Small Bowel Congenital Anomalies: a Review and Update [J]. Curr Gastroenterol Rep, 2016, 18(4): 16.
[1] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1061-1067.
[2] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[3] 张宝富, 俞劲, 叶菁菁, 俞建根, 马晓辉, 刘喜旺. 先天性原发隔异位型肺静脉异位引流的超声心动图诊断[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1074-1080.
[4] 韩丹, 王婷, 肖欢, 朱丽容, 陈镜宇, 唐毅. 超声造影与增强CT对儿童肝脏良恶性病变诊断价值的对比分析[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 939-944.
[5] 刘婷婷, 林妍冰, 汪珊, 陈幕荣, 唐子鉴, 代东伶, 夏焙. 超声衰减参数成像评价儿童代谢相关脂肪性肝病的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 787-794.
[6] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[7] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[8] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[9] 袁媛, 赵良平, 刘智慧, 张丽萍, 谭丽梅, 閤梦琴. 子宫内膜癌组织中miR-25-3p、PTEN的表达及与病理参数的关系[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1016-1020.
[10] 刘笑笑, 张小杉, 刘群, 马岚, 段莎莎, 施依璐, 张敏洁, 王雅晳. 中国学龄前儿童先天性心脏病流行病学研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1021-1024.
[11] 陆志峰, 周佳佳, 梁舒. 虚拟现实技术在治疗弱视中的临床应用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 891-895.
[12] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[13] 岳瑞雪, 孔令欣, 郝鑫, 杨进强, 韩猛, 崔国忠, 王建军, 张志生, 孔凡庭, 张维, 何文博, 李现桥, 周新平, 徐东宏, 胡崇珠. 乳腺癌HER2蛋白表达水平预测新辅助治疗疗效的真实世界研究[J]. 中华临床医师杂志(电子版), 2023, 17(07): 765-770.
[14] 周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
[15] 李静, 张玲玲, 邢伟. 兴趣诱导理念用于小儿手术麻醉诱导前的价值及其对家属满意度的影响[J]. 中华临床医师杂志(电子版), 2023, 17(07): 812-817.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号