儿童吞食磁力珠致胃肠道损伤的临床研究  

Gastrointestinal injury caused by an ingestion of magnetic beads in children

作　　者：苏泽礼[1] 梁仁章 刘冬[1] 柳琪[1] 田选恩[1] 单振潮[1] Su Zeli;Liang Renzhang;Liu Dong;Liu Qi;Tian Xuan'en;Shan Zhenchao(Department of Pediatric Surgery,General Hospital,Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院小儿外科,银川750004

出　　处：《中华小儿外科杂志》2021年第3期214-219,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨儿童吞食磁力珠致胃肠道损伤的临床特点、致病机制及诊疗方法。方法回顾性分析2017年1月至2020年2月宁夏医科大学总医院收治30例吞食磁力珠致胃肠道损伤患儿的临床资料。其中,男18例,女12例;年龄范围为1~10岁,患儿年龄为1岁的占33.33%(10/30),3岁以下占63.3%(19/30),6岁以下占80.0%(24/30)。所有患儿中26例有磁力珠接触史,其中13例吞食时间明确,吞食数目2~24枚。起病时间为数十分钟到数天不等,多在吞食数小时后发病。病程最短3 h,最长的3个月余。早期可无明显不适,逐渐出现腹痛、呕吐等,也可始终无明显症状。腹部X线片显示多个同等大小的圆形高密度影,呈串珠状或团状分布,动态观察可见位置固定,一般无膈下游离气体征象。根据磁力珠所在部位、是否出现胃肠道穿孔,采取不同的治疗方法。结果通过胃镜取出的6例均有胃黏膜水肿、溃疡等。腹腔探查的24例中,均有胃肠道穿孔或瘘形成,其中致2处损伤17例,3处损伤1例,4处损伤2例,6处损伤2例,5处损伤1例,8处损伤1例;6例在胃肠道间同时夹有肠系膜,致肠系膜穿孔,3例在胃肠道间夹有没有磁力珠的其他肠管致该段肠管肠壁穿孔;2例同时出现肠扭转,1例同时出现腹内疝;1例发现合并有回肠梅克尔憩室。胃镜取出异物的6例,2个月后复查胃镜示胃损伤恢复正常。开腹手术取出的24例,消化道功能恢复后予进食;十二指肠、结肠肠管内置蘑菇头乳胶管引流的均在术后2~3周拔除引流管;结肠造瘘在术后3个月行关瘘手术。1例术后出现伤口感染,1例术后3个月出现肠粘连遂行二次手术。所有患儿的治疗均获得满意的疗效。结论儿童吞食磁力珠危害极大,应及时采取外科干预措施,尽早争取胃镜下取出是关键。Objective To explore the clinical characteristics,pathogenesis,diagnosis and treatment of gastrointestinal injury caused by an ingestion of magnetic beads in children.Methods The clinical data of 30 children with gastrointestinal injury caused by swallowing magnetic beads were retrospectively analyzed in the Ningxia Medical University from January 2017 to February 2020.There were 18 boys and 12 girls with an age range from 1 to 10 years.The age was under 1 year(33.33%,10/30),under 3 years(63.3%,19/30)and under 6 years(80.0%,24/30).Among them,26 had a history of contact with magnetic beads and 13 of them had a definite swallowing time.The number of swallowed beads was 2-24.Onset time varied from tens of minutes to a few days.With an onset of several hours,disease course lasted from 3h to over 3 months.Initially there was no obvious discomfort.Abdominal pain and vomiting appeared gradually.Some cases were free of any symptom.Abdominal radiography showed multiple circular high-density images of the same size and the distribution was in a beadlike or lump-like manner.Dynamic observation showed that the locations were fixed and generally there was no sign of free gas under diaphragm.According to the location of magnetic beads and whether or not there was gastrointestinal perforation,different treatments were offered.Results Gastric mucosa edema and ulcer were observed in all 6 cases.Among 24 cases of abdominal cavity exploration,gastrointestinal perforation or fistula was found in 2 injuries(n=17),3 injuries(n=1),4 injuries(n=2),6 injuries(n=3),5 injuries(n=1)and 8 injuries(n=1).In 6 cases,mesentery was sandwiched between gastrointestinal tract,resulting in mesentery perforation.In another 3 cases,mesentery wall perforation was caused by sandwiching other intestinal tubes without magnetic beads between gastrointestinal tract.There were intestinal volvulus(n=2),internal hernia(n=1)and ileal Meckel's diverticulum(n=1).Foreign body was removed by gastroscopy in 6 cases.Gastroscopic reexamination at Month 2 showed that ga

关 键 词：磁性异物 胃肠道损伤 

分 类 号：R726.5[医药卫生—儿科]