Congenital Narrowing Esophagus
overview
Congenital esophageal strictures (CES) refers to congenitalesophagostenosis, born after the existing structure internal pipe for eating of narrow deformity. After dinner is characteristic of food intake, half solid or solid food is more obvious symptoms. Reverse flow saliva and main content for indigestion, milk or food and also contains no bile acid. Patients can appear choke cough or cyanosis. Older son oppression by things, or bronchial trachea panting.
Disease
Congenital esophageal strictures (CES) refers to congenitalesophagostenosis, born after the existing structure internal pipe for eating of narrow deformity. In very rare, more than youth, often need surgery. Clinically, should pay attention to distinguish the esophagus narrow secondary.
Symptoms
Congenital esophageal narrow characteristics after dinner is the food intake, half solid or solid food is more obvious symptoms. Reverse flow saliva and main content for indigestion, milk or food and also contains no bile acid. The food into the trachea, patients can appear choke cough or cyanosis. Some of the older son, due to the proximal esophageal anomaly, be being the capsular bag, food can be produced, oppression or bronchial trachea panting. Body: no special pathological signs, some patients may have malnutrition, or anemia.
Cause disease
This is because of esophageal embryonic development process. The trachea and esophagus diaphragm basal parts or esophageal side crest in embryo leaf composition of excessive proliferation, occurs in trachea bifurcate following position.
Pathological physiology
During embryonic development, formed vacuoles esophageal mucosa, redundant stage is absorbed, empty bubble disappear, but left part or all of the esophageal mucosa annular diaphragm. Others think is due to the developmental process of esophageal squamous epithelial cells replaced villi columnar epithelium caused by excessive growth when. According to the characteristics of congenital esophageal pathology, narrow Nihoul – Fekete (1987) which is divided into three types:
1 membrane web or diaphragmatic form: also called membrane samples, is the most rare narrow a type, some think it was a confusion of esophageal atresia, often occur in middle or the lower esophagus. Membrane structure surface are diaphragmatic or squamous cover, the typical symptom onset age in feeding on’t solid food.
Fiber muscular hypertrophy, say again idiopathic hypertrophic or fiber muscular, congenital muscular narrow is the most common esophageal narrow one. Histology characteristics is smooth muscle fibers and fiber submucosal connective tissue hyperplasia and normal squamous epithelium, is similar to hypertrophic pyloric stenosis, but no definite embryos and pathogenic factors to explain this disease.
3 feed pipe remaining bronchus organization, say again: the tracheal stenosis, its type stray into the air tube and bronchus remaining content is probably embryo foregut head crest plait of deformity. Frey, 1936 and Duschel first reported by 1 19 women died and she missed cardia for autopsy found. Then the stan-holder etc (1964) special attention 1058 cases of esophageal atresia baby esophageal end stenosis. In 1973, the foundation is Spitz confirmed congenital lesions. Since 1991 in English, German, offering nearly 50 cases reported in the secondary to the esophagus remaining bronchus organization of congenital esophageal stenosis caused by things.
Congenital esophageal stenosis in the upper section or under the esophagus, some reports about 50% of the esophagus in 1/3, 25% of the esophagus in next 1/3 segments. Fiber muscular hypertrophy intrathoracic esophagus in narrow or lower esophagus and feed pipe remaining bronchus organization model, narrow, in the lower esophagus.
Treatments
1.surgical method
(1) esophageal dilatation esophageal dilatation is an effective treatment methods, in recent years, with the expansion of the rigid air instead of expansion. Applicable to membrane web of thinner.
(2) membrane webbed if resection membranous webbed thick and tough, expansion, can cut esophageal mucosa, resection and annular esophageal squamous mucosa to approach. Also in endoscopic successful resection of congenital esophageal webbed. When necessary, postoperative continues to expand.
(3) esophageal partial nephrectomy to secondary to the trachea, remaining bronchus organization of congenital esophageal narrow and fiber muscle hypertrophic narrow feasible esophageal resection. Stricture 3cm < can part in narrow excision, given the esophagus anastomosis, end in HuiYan and protect the vagus nerve. For long fiber muscle hypertrophy of congenital esophageal dilatation, the narrow void can make the operation. As narrow near gastroesophageal links, recommendation for segmental resection, and make esophagus anastomosis against reverse flow, The latter has improved Hill of fixation, Nissen stomach ulcers fold place to prevent reverse flow. Collis stomach angioplasty has also been reported is an effective treatment esophageal shorten and postoperative gastroesophageal reflux.
2.surgery path choice orientation and key is clear stenosis site operation and operation way, the most commonly used on the way, but left midway through the narrow road tends to help. If the lower abdominal can narrow path. During the operation of air within the esophagus placement for correct positioning. Expand