背景:食管闭锁修复后最常见的并发症是吻合口狭窄的形成。最初的治疗是内窥镜扩张。对于复发性狭窄,病灶内注射类固醇(ISI)可能是一种有效的辅助治疗方法。在本系列中,我们将介绍我们对这种干预的初步经验。
方法:初级手术数据,狭窄治疗,术后并发症,从电子病历中回顾性收集结局和生长情况.结果采用描述性统计和混合模型分析。
结果:在2014年至2017年之间,对6例患者(注射时的中位年龄为12.4(2.1-34.7)个月)的严重复发性吻合口狭窄进行了ISI治疗。在5例患者中,ISI成功并清除了狭窄。无术后并发症报告,尤其是与急性肾上腺抑制无关。比较前一年和后一年,体重显著正变化(r=0.70,p=0.003),身高显著负变化(r=-0.87,p=0.003).
结论:我们发现ISI是食管闭锁修复术后复发性吻合口狭窄扩张的有效辅助治疗方法,无术后并发症或肾上腺抑制症状。这仍然很重要,然而,监测生长效应。在大型前瞻性研究中需要进一步评估。
方法:治疗研究,四级(病例系列)。
BACKGROUND: The most frequent complication after esophageal atresia repair remains anastomotic stricture formation. The initial treatment is endoscopic dilatation. Intralesional steroid injection (ISI) might be an effective adjuvant treatment in case of recurrent strictures. In this series we present our initial experience with this intervention.
METHODS: Data on primary surgery, stricture treatment, postoperative complications, outcome and growth were retrospectively collected from electronic patient records. Findings were analyzed by descriptive statistics and mixed model analysis.
RESULTS: Between 2014 and 2017, ISI was performed for severe recurrent anastomotic strictures in six patients (median age at injection 12.4 (2.1-34.7) months) after a median of 6 (2-20) dilatations. In five patients ISI was successful and the stenosis was cleared. No postoperative complications were reported, especially none related to acute adrenal suppression. Comparing the year before with the year after ISI, a significant positive change for weight (r = 0.70, p = 0.003) was calculated versus a negative change for height (r = -0.87, p = 0.003).
CONCLUSIONS: We found ISI to be an effective adjuvant treatment to recurrent anastomotic stricture dilatation after esophageal atresia repair, without postoperative complications or symptoms of adrenal suppression. It remains important, however, to monitor growth effects. Further evaluation is required in a large prospective study.
METHODS: Treatment study, Level IV (case series).