胃镜难以处理的食管异物临床特点分析  

Clinical features of esophageal foreign bodies difficult to remove by gastroscopy

作　　者：赵宇[1] 罗和生[1] 崔凝[1] 全晓静 Zhao Yu1, Luo Hesheng 1, Cui Ning 1, Quan Xiaojing2(1 Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China; 2Department of Gastroenterology, Shanghai First People＇s Hospital, Shanghai 200000, Chin)

机构地区：[1]武汉大学人民医院消化内科,430060 [2]上海市第一人民医院消化内科,200000

出　　处：《中华全科医师杂志》2018年第5期379-382,共4页Chinese Journal of General Practitioners

摘　　要：目的 探讨胃镜难以处理的食管异物的临床特点.方法 回顾性分析2013年1月至2017年4月于武汉大学人民医院行胃镜检查发现食管异物的共159例患者的临床资料,将经胃镜直接取出异物的患者分为胃镜组（101例）,将难以胃镜下处理而转行食管镜或外科手术的患者分为非胃镜组（58例,其中食管镜组42例,外科手术组16例）.回顾分析两组患者的一般情况、异物类型与嵌顿情况、治疗方式及转归.结果 两组患者平均年龄、性别比较差异无统计学意义（均P ＞0.05）.食管异物类型包括食源性异物和非食源性异物,食源性异物中鱼骨77例、鸡骨45例、枣核15例、食管团块4例,非食源性异物中眼镜片2例、酒瓶盖11例、义齿5例.胃镜组63.4％ （64/101）异物嵌顿发生于食管上段;非胃镜组中,食管镜组66.7％（28/42）异物嵌顿发生于食管上段,手术组10例（10/16）发生于食管中段.胃镜组3.9％（4/101）锐性异物长径＞2 cm;非胃镜组中,食管镜组7.1％（3/42）、手术组9例（9/16）锐性异物长径＞2 cm.159例患者均成功取出食管异物,胃镜组101例,其中黏膜擦伤出血93例,轻度活动性出血5例,食管瘘1例;非胃镜组58例,16例经胸外科手术取出,4例术后出现食管穿孔并周围炎,3例出现纵隔炎,2例可见纵隔脓肿;另42例均由食管镜取出,2例出现食管肌层脓肿,1例出现食管瘘,1例出现肺部感染.结论 食管异物类型以食源性异物最常见,胃镜难以处理的食管异物嵌顿位置以食管上段、中段多见,食管中段尖锐异物嵌顿时直接取出异物易引发食管瘘或主动脉大出血等严重并发症,此时宜行外科手术治疗.Objective To analyze the clinical features of esophageal foreign body（EFB） difficult to remove by gastroscopy.Methods The clinical data of 159 patients with EFBs treated in Renmin Hospital of Wuhan University from January 2013 to April 2017 were analyzed retrospectively.Among 159 cases,the EFBs were removed by gastroscopy in 101 cases（gastroscope group）and removed by non-gastroscope method in 58 cases （non-gastroscope group）,including 42 cases removed by esophagoscopy and 16 cases by surgery.The general information of patients,the types of EFB,the condition of impaction,treatments and outcomes of the two groups were analyzed.Results There was no significant difference in age and sex between gastroscope group and non-gastroscope group （P 〉 0.05）.The food typeEFBs included fish bone （n =77）,chicken bone （n =45）,jujube seeds （n =15）,food bolus （n =4）;and the non-food type FEBs included spectecleslens （n =2）,bottle cap （n =11）,denture （n =5）.More than one half of FBs were located in the upper esophagus：63.4% （64/101） in gastroscope group and 66.7% （28/42） in esophagoscope subgroup;however,EFBs were mostly located in the middle esophagus in surgery subgroup （62.5%,10/16）.In gastroscope group and esophagoscope subgroup,the sharp EFBs of length-diameter 〉 2 cm were rare（n =4,3.9% and n =3,7.1%）,but were common in the surgery group （n =9,56.3%）.The EFBs were successfully removed in all patients without massive hemorrhage or death.In gastroscope group （n =101）,93 cases had mucosal abrasion and bleeding,5 cases had mild active bleeding,and 1 case had esophageal fistula.In surgical removal （n =16） there were 4 cases of esophageal perforation and postoperative inflammation,3 cases of mediastinal inflammation and 2 cases of mediastinal abscess.Inesophagoscopic removal group （n =42）,there were 2 cases of esophageal muscle layer abscess,1 case of esophageal fistula and 1 case of pulmonary infection.Conclusions The most common type of EFBs is of fo

关 键 词：食管 异物 胃镜 食管镜检查 外科手术 

分 类 号：R768.32[医药卫生—耳鼻咽喉科]