儿童消化道异物21例手术治疗分析  

Clinical experience of ingested intraabdominal foreign bodies in children requiring surgical intervention

作　　者：陈巍[1] 王晓曼[2] 刘婷婷[3] 王大勇[1] 张廷冲[1] 陈亚军[1] Chen Wei;Wang Xiaoman;Liu Tingting;Wang Dayong;Zhang Tingchong;Chen Yajun(Department of General Surgery,Beijing Children’s Hospital,Capital Medical University,Children’s National Medical Center,Beijing 100045,China;Department of Ultrasound,Beijing Children’s Hospital,Capital Medical University,Children’s National Medical Center,Beijing 100045,China;Department of Emergency Medicine,Affiliated Beijing Children’s Hospital,Capital Medical University,Children’s National Medical Center,Beijing 100045,China)

机构地区：[1]国家儿童医学中心(北京),首都医科大学附属北京儿童医院普通外科,北京市100045 [2]国家儿童医学中心(北京),首都医科大学附属北京儿童医院腹部超声科,北京市100045 [3]国家儿童医学中心(北京),首都医科大学附属北京儿童医院急诊科,北京市100045

出　　处：《临床小儿外科杂志》2021年第8期778-784,共7页Journal of Clinical Pediatric Surgery

基　　金：北京市医院管理局儿科学科协同发展中心专项经费资助(编号:XTYB201824)。

摘　　要：目的总结需要手术治疗的儿童腹部消化道异物的临床诊治经验。方法回顾性分析首都医科大学附属北京儿童医院2007年5月至2017年8月收治的21例行腹部手术的儿童消化道异物患者资料,其中男17例,女4例,平均年龄(3.15±2.89)岁,年龄范围10个月至11岁4个月。结果哭闹、腹痛(11例,68.8%)和呕吐(10例,62.5%)是需手术治疗的儿童腹部消化道异物患者的主要症状。所有患者中,X线平片检查提示消化道异物阳性者13例,包括尖锐性金属异物3例、硬币1例、纽扣电池1例、单个磁性异物1例、多个磁性异物6例;X线平片检查提示消化道异物阴性者8例,包括泡发球5例、枣核2例、棒棒糖棍1例。超声检查对腹部消化道异物的诊断准确率为100%,而X线平片诊断准确率仅61.9%。所有患者接受开腹手术治疗;5例无消化道并发症患者中,4例行消化道切开异物取出术,1例(异物为钢针)开腹手术时发现钢针位于腹股沟疝囊,予以取出。16例存在消化道并发症的患者(胃穿孔1例,肠穿孔10例,肠梗阻5例)中,除1例泡发球致肠梗阻患者行开腹手术肠外手法捏碎异物外,其余均行穿孔修补、肠切开或肠切除吻合术。术后随访3~6个月,均恢复良好。结论儿童消化道异物可引起较为严重的并发症。吞食多个磁性异物及泡发球易引起消化道并发症,需要患者家长及儿科医生重点关注。Objective To summarize our clinical experiences of managing children with abdominal digestive tract foreign bodies(FB)requiring surgical intervention.Methods A retrospective study was performed for 21 children with FBs in digestive tract undergoing surgery between May 2007 and August 2017.There were 17 boys and 4 girls(M∶F=4.25∶1)with a mean age of(3.15±2.89)years(10 months to 11.3 years).The clinical data were analyzed and the clinical experiences of diagnosis and treatment summarized.Results The major clinical manifestation included crying&abdominal pain(n=11,68.8%)and vomiting(n=10,62.5%).All children underwent abdominal radiography and abdominal ultrasonography pre-operation.Thirteen cases of positive foreign body on radiography included sharp metal foreign body(n=3),coin(n=1),button battery(n=1),single magnetic foreign body(n=1)and multiple magnetic metal foreign bodies(n=6).Eight cases of radiography negative digestive tract foreign bodies included 5 cases of superabsorbent objects,2 cases of jujube nucleus,and 1 case of lollipop stick.The ultrasonic diagnostic rate of abdominal foreign body was 100%while only 61.9%of intraabdominal foreign bodies were positive on radiograph.All children underwent laparotomy and 4/5 of them without gastrointestinal complications underwent enterotomy for removing foreign bodies.One cases had a steel needle in inguinal hernia sac.The gastrointestinal complications include gastric rupture(n=1),intestinal perforation(n=10)and intestinal obstruction(n=5).In one case of intestinal obstruction by a superabsorbent object,foreign body was crumbed during laparotomy.Other children underwent perforation repair through enterotomy or enterectomy.There were no postoperative complications.The children recovered well after a follow-up period of 3-6 months.Conclusion Foreign bodies in digestive tract of children may cause serious complications.Swallowing multiple magnetic foreign bodies and superabsorbent object lead to gastrointestinal complications.It should attract the attention of p

关 键 词：胃肠道 外科手术 异物/外科学 异物/影像诊断 治疗结果 儿童 

分 类 号：R726.56[医药卫生—儿科] R726.1[医药卫生—临床医学]