儿童纽扣电池食道异物临床特点及风险状态分析  

Analysis of clinical features and risk state of children with esophageal button-battery impaction

作　　者：段清川 王桂香[1] 王华[1] 刘志勇 刘雨薇 李宏彬 杨小健[1] 赵靖[1] 张杰[1] DUAN Qingchuan;WANG Guixiang;WANG Hua;LIU Zhiyong;LIU Yuwei;LI Hongbin;YANG Xiaojian;ZHAO Jing;ZHANG Jie(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Children′s Hospital,Capital Medical UniversityNational Center for Children′s Health,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery,100045,Beijing,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院耳鼻咽喉头颈外科儿童耳鼻咽喉头颈外科疾病北京市重点实验室

出　　处：《中国医药导报》2019年第23期146-149,155,共5页China Medical Herald

摘　　要：目的分析28例纽扣电池食道异物儿童的临床特征,为指导临床诊治提供依据。方法回顾性分析2016年3月~2019年3月就诊于首都医科大学附属北京儿童医院耳鼻喉科的28例纽扣电池食道异物儿童的临床资料,对其年龄特点、异物存留时间、症状、并发症等进行分析。结果28例患儿中男性21例,女性7例,中位年龄19个月,中位嵌顿时间为7.5 h。常见的首发症状为呕吐(10例)及吞咽或喂养困难(9例)。24例(85.7%)患儿通过X线诊断,3例(10.7%)行内镜检查确诊,另1例患儿经CT诊断。所有患者均手术取出异物并留置胃管至术后2~4周,患儿自就诊到异物取出平均在2 h内完成(范围1~5 h)。异物多数位于食道上段(19例,67.9%),其次为食道下段(6例,21.4%),仅3例异物位于食道中段。患儿中位住院时间为7 d(范围2~21 d),3例患儿发生气管食管瘘(10.7%)术后并发症,其中2例治疗后恢复,1例患儿死亡。有并发症与无并发症患儿中位年龄及异物嵌顿时间比较,差异无统计学意义(P>0.05)。有并发症患儿中位住院时间明显长于无并发症患儿,差异有高度统计学意义(P<0.01)。结论纽扣电池食道异物患儿需急诊手术取出异物,留置胃管,密切观察并积极处理并发症。Objective To analyze the clinical features of 28 children with esophageal foreign body due to button-battery ingestion in order to guide the clinical work in these situation.Methods Clinical data of 28 children with esophageal foreign body due to button-battery ingestion in Department of Otorhinolaryngology Head and Neck Surgery of the Beijing Children′s Hospital,Capital Medical University from March 2016 to March 2019 were retrospectively analyzed,the age,impaction time,symptoms and complications of children were analyzed.Results There were 21 boys and 7 girls with a median age of 19 months were included,the median esophageal impaction time was 7.5 h.The most common symptoms were vomiting(10 cases)and dysphagia(9 cases).24 cases(85.7%)were diagnosed with X-ray,while 3 cases(10.7%)were diagnosed with endoscopy,the other one was diagnosed with CT scan.Batteries of all children were taken out underwent surgery and given nasogastric tube until 2 to 4 weeks after sugery.The average time from chidren presentation to removal of the battery was 2 h(range of 1 to 5 h).Most batteries(19 cases,67.9%)were impacted at the upper portion of the esophagus,followed by the lower portion(6 cases,21.4%),and only 3 cases were at the middle portion.The median hospital stay was 7 d(range of 2 to 21 d).3 cases(10.7%)had tracheoesophageal fistula.2 cases of them recovered with effective treatment and one died.The median age and impaction time between children with and without complication had no statistics significant difference(P>0.05).The median of hospital stay of children with complication was longer than the children without complication,the difference was highly statistically significant(P<0.01).Conclusion Children with esophageal button-battery impaction should be taken into emergent operation to get rid of the battery and indwelling gastric tube,close observation is necessary for monitoring and managing the complications.

关 键 词：纽扣电池 食道异物 儿童 

分 类 号：R7226.494[医药卫生—儿科]