171例食管上段异物的内镜治疗

发布时间：2018-01-31 03:07

本文关键词： 食管异物食管内镜　出处：《北京大学学报(医学版)》2014年01期 　论文类型：期刊论文

【摘要】：目的:评估食管上段异物嵌顿后并发症的发生率,比较软式及硬式内镜治疗效果。方法:回顾性分析北京大学第三医院2008年1月至2012年12月经内镜治疗的171例食管上段异物病例资料。结果:126例食管上段异物行硬式内镜治疗,45例行软式内镜治疗:(1)软式内镜组所取异物的平均长径和短径与硬式内镜组比较差异无统计学意义(P=0.495,P=0.125);(2)硬式内镜组异物嵌顿时间[(25.8±28.6)h]比软式内镜组[(13.9±14.5)h]更长,差异有统计学意义(P=0.009);(3)90例(71.4%,90/126)硬式内镜组患者于24 h内就诊,19例(15.1%,19/126)于24~48 h就诊,17例(13.5%,17/126)超过48 h就诊;软式内镜组88.9%(40/45)于24 h内就诊,4例(8.9%,4/45)于24~48 h就诊,仅有1例(1/45,2.2%)超过48 h就诊;(4)硬式内镜组85例(67.5%,85/126)异物一端或两端刺入食管壁,而软式内镜组上述比例为35.6%(16/45);(5)硬式内镜和软式内镜治疗前上消化道钡剂造影诊断异物的阳性率分别为98.3%和100%,而胸片或腹平片对异物诊断的阳性率两组分别为23.6%和14.3%;(6)硬式内镜组治疗成功率、并发症发生率及穿孔率分别为100%、38.1%和6.3%。软式内镜组则分别为95.6%、48.9%和2.2%,二者比较差异均无统计学意义(P均0.05)。结论:硬式内镜与软式内镜相比二者取食管异物并发症发生率和穿孔率无区别,二者取异物成功率均较高,但软式内镜无需全身麻醉,患者恢复快,费用低。
[Abstract]:Objective: to evaluate the incidence of complications after upper esophageal foreign body incarceration. Methods: the data of 171 cases of upper esophageal foreign body treated by endoscopic therapy from January 2008 to 2012 in Peking University third Hospital were analyzed retrospectively. 126 cases of upper esophageal foreign bodies were treated with rigid endoscopy. The average length and short diameter of foreign body in soft endoscopy group were not significantly different from those in rigid endoscopy group. Time of foreign body incarceration in rigid endoscopic group. [25.8 卤28.6 hours compared with soft endoscopy group. [It was longer than 13.9 卤14.5h. the difference was statistically significant (P 0.009). In the rigid endoscopic group, there were 19 patients (15.1 / 126) in 24 hours and 19 patients in the rigid endoscopy group at 2448 hours. 17 patients with 13. 5 / 12. 6) were treated for more than 48 hours. In the soft endoscopy group (88.9 / 40 / 45), 4 cases (8.9 / 45 / 45) were treated in 24 h, and only 1 case (1 / 45) in 24 h. 2.2) for more than 48 hours; (4) in the rigid endoscopic group, 85 cases (85 / 126) of foreign bodies were punctured into the esophageal wall at one end or at both ends, whereas in the soft endoscopy group, the ratio was 35.610 / 16 / 45; (5) the positive rates of barium radiography in upper digestive tract before rigid endoscopy and soft endoscopy were 98.3% and 100%, respectively. The positive rates of chest radiographs and abdominal plain films for the diagnosis of foreign bodies were 23.6% and 14.3 in the two groups, respectively. The success rate, complication rate and perforation rate of rigid endoscopy group were 100% and 6. 3%, respectively, while those of soft endoscopy group were 95. 6% and 2.2% respectively. Conclusion: the incidence of complications and perforation rate of esophagus foreign body in rigid endoscopy and soft endoscopy are not different, and the success rate of foreign body extraction in both two groups is higher than that in soft endoscopy. But soft endoscopy does not require general anesthesia, patients recover quickly and the cost is low.
【作者单位】：北京大学第三医院消化科;北京大学第三医院耳鼻喉科;
【基金】：国家自然科学基金(81100261)资助~~
【分类号】：R768.32
【正文快照】： 由于误服、食管狭窄及其他某些特殊原因(如精神异常)导致吞咽异物和食管团块嵌顿于食管时有发生,是仅次于消化道出血的内镜急症之一。美国每年由于吞咽异物和食管团块嵌顿而导致死亡的病例约有1 500例[1-2],而中国目前尚未见食管异物发病率的相关数据。吞咽异物大多发生于6岁

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