小儿上消化道异物的内镜治疗  

Endoscopic treatment for foreign objects in upper gastrointestinal tract in children

作　　者：赵志峰[1] 麻树人[1] 张宁[1] 杨卓[1] 赵云峰[1] 高飞[1] 韩笑[1] 高峰[1] 宫照洁[1] 杨琳[1] 

机构地区：[1]沈阳军区总医院内窥镜科,沈阳110016

出　　处：《解放军医学杂志》2009年第11期1365-1367,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨小儿上消化道异物内镜治疗的特点与策略。方法2004年1月至2009年6月沈阳军区总医院内窥镜科急诊救治的10岁以下上消化道异物患儿32例,回顾性分析其临床资料和治疗数据。结果32例患儿治疗均取得成功,无并发症发生,死亡率为0%,其中2～4岁小儿病例数占53.1%(17/32)。取出异物及相应患儿例数分别为:5角硬币7例,1元硬币10例,项链坠4例,戒指4例,钢钉1例,口腔科根管治疗针1例,桂圆核1例,铁拉锁头1例,铜钱币1例,鱼刺1例,指甲刀配件1例。32例患儿中应用水合氯醛灌肠法镇静麻醉10例,应用安定镇静1例。食管异物嵌顿18例,包括食管第一狭窄处5例,第二狭窄处7例,第三狭窄处6例;胃内异物14例。在患者配合良好的情况下,内镜下取出异物所需要的时间一般为2～5min;胃内异物取出因受食物干扰,所需时间达8min。结论急诊内镜是治疗小儿上消化道异物的首选方法,安全、可靠。简单麻醉和特殊技巧的应用是进一步提高治疗水平的重要方法。Objective To evaluate the feature and strategy in endoscopic treatment for foreign objects in the esophagus and upper gastrointestinal tract in children. Methods The clinical data of 32 patients,collected from Jan. 2004 to Jun. 2009,were retrospectively analyzed. All the patients were younger than 10 years old,and had undergone endoscopic emergency treatment for foreign objects lodged in esophagus and upper gastrointestinal tract. Results The successful rate of endoscopic treatment was 100%. The mortality and incidence of complication were zero. Of the 32 patients,17 were from 2 to 4 years old （53.1%）. The foreign objects included 7 coins in nominal value of 50 cent,10 coins in nominal value of 1 yuan,4 necklace pendants,4 rings,1 steel nail,1 needle used for root canal therapy,1 seed of longan,1 zipper ring,1 copper coin,1 case of fish bone and 1 spare part of nail clipper. Of the 32 cases,10 received sedation and narcotization with chloral hydrate enteroclysm,and one was given diazepam for sedation. Incarceration of foreign objects in esophagus was found in 18 patients,including 5 cases at the first isthmus,7 cases at the second isthmus and 6 cases at the third isthmus of esophagus. Foreign objects in the stomach were seen in 14 patients. Generally,foreign objects were dislodged within 2 to 5 minutes when patients was cooperative with the operator. It always took a longer time to dislodge the foreign objects from stomach than from the esophagus because of the interference of food in stomach. Conclusions Endoscopic therapy,which is simple,safe and effective,should be the first choice for childhood patients with foreign bodies lodged in esophagus and upper gastrointestinal tract. Skillful endoscopic technic with proper anesthesia can improve the therapeutic effects of removing foreign bodies from upper digestive tract in children.

关 键 词：内镜 异物 胃肠道 儿童 

分 类 号：R57[医药卫生—消化系统]