儿童消化道异物1257例病例系列报告

发布时间：2018-04-01 07:52

本文选题：消化道异物　切入点：儿童　出处：《中国循证儿科杂志》2017年05期

【摘要】：目的总结儿童消化道异物特点和预后,为临床治疗和预后判断提供依据和指导。方法回顾性收集广东省广州市妇女儿童医疗中心确诊为消化道异物的病例,根据异物性质和位置确定门诊观察和住院观察取异物,建立资料采集表格,单人采集如下信息:年龄、异物类型、停留部位、误吞时间、临床症状、取异物地点、取异物方式、并发症、异物去向。结果2006年5月至2016年10月1 257例消化道异物纳入分析,男845例,平均(3.0±2.1)岁,误吞异物时间(1.7±1.5)d。出现临床症状266例(21.2%),其中上消化道症状210例(78.9%)。硬币类异物比例最高(53.2%),其余为电池、磁铁、长条/尖锐异物和不规则异物。就诊时异物停留在胃内最多见(40.8%)。自行排出异物者215例,时间(3.5±2.5)d。门诊观察806例中自行排出185例(23.0%);住院观察治疗451例中自行排出30例(6.6%),干预取出420例,其中食管镜取出230例(54.8%),尝试胃镜取出169例(40.2%),外科手术取出21例(5.0%)。门诊观察和住院取异物病例中出现并发症110例(8.8%),其中98例(86.4%)出现黏膜损害,2例食管异物因并发食管穿孔、主动脉食管瘘导致消化道出血死亡。以Logistic二元回归对预后进行危险因素分析显示,临床症状、停留部位、干预方式和异物类型是儿童消化道异物预后的独立危险因素。长条/尖锐物的内镜干预率(49.2%)和临床症状出现率(32.3%)均最高,磁铁异物外科手术率(17.4%)最高,纽扣电池并发症发生率(25%)最高;食道异物的内镜干预率(78%)、症状出现率(68.8%)和并发症发生率(16.6%)均最高。结论儿童消化道异物类型多种多样,预后与异物类型、停留部位、临床症状和干预方式密切相关。
[Abstract]:Objective to summarize the characteristics and prognosis of digestive tract foreign bodies in children, and to provide basis and guidance for clinical treatment and prognosis.Methods the cases of foreign bodies in digestive tract diagnosed by Guangzhou Women's and Children's Medical Center in Guangdong Province were collected retrospectively. According to the nature and location of foreign bodies, the foreign bodies were selected for outpatient observation and inpatient observation, and the data collection forms were established.Single person collects the following information: age, type of foreign body, stay position, time of false swallowing, clinical symptoms, location of foreign body, ways of taking foreign body, complication, destination of foreign body.Results from May 2006 to October 2016, 1 257 cases of foreign bodies in digestive tract were included in the analysis. 845 cases were male (mean 3.0 卤2.1) years old, and the time of ingesting foreign bodies by mistake was 1.7 卤1.5 days.There were 266 cases with clinical symptoms, including 210 cases with upper digestive tract symptoms (78.9%).The proportion of coin type foreign bodies is the highest (53.2%), the rest are batteries, magnets, long / sharp foreign bodies and irregular foreign bodies.At the time of seeing a doctor, 40.8% of foreign bodies remained in the stomach.215 cases of foreign bodies were discharged by themselves, the time was 3.5 卤2.5 days.Out of 806 cases, 185 cases were discharged by themselves, 30 out of 451 cases were treated by inpatient observation, and 420 cases were taken out by intervention. Among them, 230 cases were removed by esophagoscope, 169 cases by gastroscope, 169 cases by gastroscopy, and 21 cases by surgery.In the outpatient observation and hospitalization, there were 110 cases of complications, including 98 cases of mucosal damage, 2 cases of esophageal foreign bodies complicated with esophageal perforation, and 2 cases of aortic esophagoesophageal fistula leading to gastrointestinal bleeding death.The risk factors of prognosis were analyzed by Logistic binary regression analysis. The clinical symptoms, stay location, intervention methods and types of foreign bodies were independent risk factors for the prognosis of children's digestive tract foreign bodies.The rate of endoscopic intervention (49.2%) and the incidence of clinical symptoms (32.3%) were the highest, the rate of surgical operation of magnet foreign body (17.4%) was the highest, and the incidence of complications of button battery was 25% (P < 0.05).The endoscopic intervention rate of foreign body in esophagus was 78%, the incidence of symptoms was 68.8%, and the incidence of complications was 16.6%.Conclusion there are various types of foreign bodies in the digestive tract of children. The prognosis is closely related to the types of foreign bodies, the location of stay, the clinical symptoms and the ways of intervention.
【作者单位】：广东省广州市妇女儿童医疗中心消化科;广东省广州市妇女儿童医疗中心放射科;
【分类号】：R725.7

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