Лечение осложнений ожогов пищевода дисковыми батарейками у детей (обзор литературы)

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Детская хирургия. Журнал им. Ю.Ф. Исакова. 2023; 27: 107-112

Лечение осложнений ожогов пищевода дисковыми батарейками у детей (обзор литературы)

Теплов В. О., Португал П. М., Разумовский А. Ю.

https://doi.org/10.55308/1560-9510-2023-27-2-107-112

Аннотация

Введение. За последние 10 лет значительно увеличилось количество тяжёлых и летальных случаев ожогов пищевода дисковыми батарейками у детей. Тактика ведения детей с осложнениями ожогов батарейками на сегодняшний день не определена во всем мире, в российских источниках описываются единичные клинические случаи.

Материал и методы. Проведён анализ литературы с 1983 по 2022 гг. по базам научных данных РИНЦ, Medline и Google Scholar. Проанализировано более 350 публикаций по данной теме.

Результаты. Основным механизмом разрушения тканей признан электролиз, который сопровождается развитием колликвационного некроза в области стояния отрицательного полюса батарейки. Необходимость нейтрализации ожога медом и 0,25 % раствором уксусной кислоты описана в официальных рекомендациях, опубликованных Национальным столичным токсикологическим центром, г. Вашингтон. Наиболее оптимальной тактикой лечения трахеопищеводных свищей после батареек является выполнение лапароскопической фундопликации и гастростомии, в результате которых может произойти спонтанное закрытие свища. В случае больших дефектов и тяжелого нестабильного состояния пациента необходимо выполнять более сложные реконструктивные вмешательства. Лечение стеноза пищевода предпочтительно проводить с помощью бужирований, а лечение перфораций – консервативно. В случае пареза или паралича гортани требуется выполнение ларингоскопии на ранних этапах для решения вопроса о трахеостомии вместо интубации трахеи. Пищеводно-аортальные свищи требуют агрессивной хирургической тактики даже при отсутствии видимого кровотечения.

Заключение. В настоящее время нет единой тактики ведения пациента ни при одном из возможных осложнений. Необходимо дальнейшее проведение статистического анализа клинических случаев, а также исследование существующих консервативных и хирургических методик, разработка новых методик оперативного лечения данной патологии. Рациональная диагностика и тактика лечения позволят снизить высокую летальность и повысить качество жизни пациентов.

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Russian Journal of Pediatric Surgery. 2023; 27: 107-112

Treatment of burn complications in the esophagus caused by button batteries in children (a literature review)

Teplov V. O., Portugal P. M., Razumovskiy A. Yu.

https://doi.org/10.55308/1560-9510-2023-27-2-107-112

Abstract

Introduction. Over the past 10 years, the number of severe and fatal cases of burns in the esophagus caused by button batteries in children has increased significantly. The tactics of managing children with complications after such burns has not been defined worldwide yet; few clinical cases are described in Russian sources.

Material and methods. The literature search has covered databases of RSCI, Medline and GoogleScholar published in 1983–2022. More than 350 publications on this topic have been analyzed.

Results. Electrolysis is recognized as the main mechanism of tissue destruction, which is accompanied by the development of colliquative necrosis in the area of negative pole of the battery. The National Capital Poison Center, Washington, USA, recommends to neutralize burns with honey and 0.25 % acetic acid solution. The most optimal tactics for managing tracheoesophageal fistulas caused by batteries is to perform laparoscopic fundoplication and gastrostomy, as a result of which spontaneous closure of the fistula may occur. In case of large defects and patient’s severe unstable condition more complicated reconstructive interventions have to be done. Esophageal stenoses should be treated with bougienage, and perforations are preferably treated conservatively. In case of laryngeal paresis or paralysis, laryngoscopy is required at the early stage so as to understand if tracheostomy is better instead of tracheal intubation. Esophageal aortic fistulas require aggressive surgical tactics even in the absence of visible bleeding.

Conclusion. Currently, there is no common management strategy in any of the possible complications. Further statistical analysis of clinical cases and assessment of existing conservative and surgical techniques are needed; development of new surgical techniques to be applied in patients with abovementioned pathology is needed as well. Rational diagnostics and curative tactics will reduce high mortality rate and improve the quality of life of such patients.

References