浙江省595例食管异物内镜治疗的临床分析

发布时间：2018-03-30 05:17

  本文选题：异物嵌顿　切入点：食管　出处：《浙江大学》2017年硕士论文

【摘要】：目的探讨食管异物嵌顿的临床特征,并分析内镜取食管异物成功率的影响因素,以及异物嵌顿后并发症发生的相关因素。方法2015年10月至2016年8月,收集浙江省内共10个地市18所医院因怀疑食管异物嵌顿至内镜中心就诊的所有病例。利用统一的调查问卷,分别收集一般资料(包括性别、年龄)、临床检查特征(包括相关疾病史、临床表现、影像学表现)以及内镜治疗相关资料(包括异物种类、大小、位置、内镜治疗辅助器械等),并统计分析食管异物嵌顿后并发症及其发生的相关因素,以及内镜取食管异物成功率及其影响因素。结果(1)纳入595例因可疑食管异物嵌顿而就诊的患者,平均年龄51.7±20.1岁。其中男性278例,女性317例。(2)最常见的主要异物种类分别为鱼刺(34.0%)、禽类骨(22.1%)、枣核(17.1%)和软性食物团块(14.6%)。其中大部分为短异物(2.5cm,74.0%),其次为中型异物(2.5～6.0cm,24.5%)和长异物(6cm,1.5%)。异物通常最容易嵌顿在食管上段(75.9%),其次为中段(15.2%)和下段(8.9%)。(3)96.3%的患者出现明显的临床症状,上段食管异物(98.1%)较远段食管异物(92.6%)更易出现临床症状(p0.001),而患者年龄、性别、异物种类与临床症状无明显相关性(p0.05)。(4)内镜取异物率达94.5%。静脉麻醉内镜(99.3%)较普通内镜(92.7%)有较高取异物成功率(p0.01);而年龄、异物滞留时间、嵌顿位置、异物是否尖锐、异物大小等因素均与取异物成功率不相关(p0.05)。(5)异物嵌顿后并发症发生率达34.0%。主要并发症包括渗血(12.3%)、黏膜糜烂(10.8%)、黏膜撕裂(9.1%)和黏膜溃疡(6.6%)等。5.6%患者发生食管穿孔事件。异物在食管滞留时间延长可增加并发症的发生风险(p0.001)。对比在12h内,滞留时间超过24h,并发症发生率提高2.2倍;滞留超过48h,并发症发生率提高6.2倍。Logistic回归分析提示尖锐异物相对非尖锐异物,并发症发生率显著升高(OR=3.36,95%CI:1.97-5.74,p0.001)。异物大小、异物嵌顿位置不是并发症发生的影响因素(p0.05)。穿孔发生率与异物滞留时间、异物是否尖锐呈显著相关(p0.01),而与嵌顿位置、异物大小不相关(p0.05)。异物滞留超过24小时和72小时后相对于12小时内的穿孔发生率显著提高13.4倍和31.1倍(p0.01)。结论(1)内镜治疗食管异物嵌顿具有较高成功率和安全性。(2)静脉麻醉可以提高内镜治疗食管异物成功率。(3)对于尖锐异物,应尽早在24小时内移除,以降低异物引起的严重并发症如穿孔。
[Abstract]:Objective to investigate the clinical features of esophageal foreign body incarceration, and to analyze the factors influencing the success rate of endoscopic foreign body extraction and the related factors of complications after foreign body incarceration. Methods from October 2015 to August 2016, A total of 18 hospitals in 10 prefectures and cities in Zhejiang province were collected for suspected esophageal foreign body incarceration to the endoscopic center. General data (including gender) were collected using a unified questionnaire. Age, clinical features (including history, clinical manifestations, imaging findings) and endoscopic treatment-related data (including types, size, location of foreign bodies), The complications after esophageal foreign body incarceration, the related factors, the success rate of endoscopic foreign body extraction and its influencing factors were statistically analyzed. Results 595 patients with suspected esophageal foreign body incarceration were included in the study. The average age was 51.7 卤20.1 years old. The most common types of foreign bodies in 317 female cases were fish prickly (34.0), poultry bone (22.1g), jujube (17.1g) and soft food lumps (14.6m), most of which were short foreign bodies (2.5cm / 74.0), followed by medium-sized foreign bodies (2.56.0cm / 24.5cm) and long foreign bodies (6cm / 1.5cm). 75.9% of the patients in the upper segment, followed by 15.2% in the middle segment, and 8.9% in the lower segment showed obvious clinical symptoms. Upper esophageal foreign body (98.1) and distal esophageal foreign body (92.6%) are more likely to appear clinical symptoms (p 0.001), and the patient's age, sex, There was no significant correlation between foreign body types and clinical symptoms (P 0.05). The rate of foreign body extraction by endoscopy was 94.5. the rate of foreign body extraction by intravenous anesthesia was 99.3) was higher than that by common endoscopy (P 0.01), but age, foreign body retention time, place of incarceration, and whether the foreign body was sharp or not were higher than those of common endoscope (P < 0.05). The incidence of complications after foreign body incarceration was 34.00.The main complications included bleeding 12.3i, mucosal erosion 10.8T, mucosal tear 9.1g) and mucosal ulcer 6.6cm).) the incidence of esophageal perforation occurred in 5.6% of the patients. Prolonged foreign body retention in the esophagus increased the risk of complications (P 0.001). The incidence of complications increased by 2.2 times over 24 hours and 6.2 times by logistic regression analysis. Logistic regression analysis showed that the incidence of acute foreign bodies was significantly higher than that of non-sharp foreign bodies, and the incidence of complications was significantly increased by 3.3695% CI: 1.97-5.74g, p 0.0010.The size of foreign bodies was significantly higher than that of non-sharp foreign bodies. The incidence of perforation was significantly correlated with the retention time of the foreign body, and there was a significant correlation between the incidence of perforation and the retention time of the foreign body, while the incidence of perforation was significantly correlated with the location of the foreign body, while the incidence of perforation was significantly correlated with the retention time of the foreign body. The incidence of foreign body perforation after 24 hours and 72 hours of foreign body retention was significantly increased by 13.4 times and 31.1 times than within 12 hours. Conclusion the endoscopic treatment of esophageal foreign body incarceration has a higher success rate and safety. Intravenous anesthesia can improve the success rate of endoscopic treatment of esophageal foreign bodies. Remove within 24 hours as early as possible to reduce serious complications such as perforation caused by foreign bodies.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R768.32
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本文编号：1684518