消化内镜诊治儿童上消化道异物穿孔临床分析  

Endoscopic management of perforation caused by foreign bodies in upper gastrointestinal tract in children

作　　者：薛宁 徐俊杰 魏绪霞 Xue Ning;Xu Junjie;Wei Xuxia(Qilu Children's Hospital,Shandong University,Jinan 250022,China)

机构地区：[1]山东大学齐鲁儿童医院,济南250022

出　　处：《中华小儿外科杂志》2022年第2期117-121,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的总结儿童上消化道异物穿孔的临床特点和预后,为临床治疗提供依据和指导。方法收集分析山东大学齐鲁儿童医院收治的19例上消化道异物穿孔患儿的临床资料。其中,男11例、女8例,年龄(2.73±1.16)岁,范围为10个月至5岁。穿孔部位以食管上段最多见,滞留上消化道时间为(2.6±1.69)d。对食管穿孔直径<5 mm的患儿放置鼻胃管保守治疗;对食管穿孔直径>5 mm或穿孔部位在胃或十二指肠球、降部者,予金属夹夹闭和(或)放置鼻胃管/鼻空肠管;胃镜取出失败者行外科手术。结果19例患儿经消化内镜下治疗,有17例患儿成功取出异物,取出失败2例;有12例患儿上消化道穿孔处给予金属夹夹闭后愈合,其中1例患儿合并空肠穿孔,空肠处穿孔经禁食、抗感染、静脉营养等治疗后愈合,3例通过放置鼻胃管/鼻空肠管后自然愈合,3例行外科手术,其中有1例术后3个月出现食管狭窄,余患儿愈后良好。另有1例纽扣电池致食管-气管瘘患儿,在异物取出后第5天突发急性肺出血死亡。结论磁性异物和纽扣电池是常见的引起儿童上消化道穿孔的异物,消化内镜检查及镜下治疗是处理上消化道异物穿孔的首选,早期诊断及干预治疗有助于减少并发症,儿童需要更多的预防措施。Objective To summarize the characteristics and prognoses of perforation caused by foreign bodies in upper gastrointestinal tract in children and provide basis and guidance for future clinical management.Methods Retrospective analysis was performed for clinical data of 19 children with perforation caused by foreign bodies in upper gastrointestinal tract.There were 11 boys and 8 girls with an age of 2.73(10/12-5)years.Upper esophagus was the most common perforation site.The average time of swallowing was(2.6±1.69)days.Conservative treatment with nasogastric tube placement for children with esophageal perforation diameter<5 mm,for esophageal perforation diameter>5 mm or the perforation site in the stomach or duodenal superior or descending part,metal clips should be clamped and/or Nasogastric/nasojejunal tube be placed,surgery for failed gastroscopy.Results Under endoscope,17 foreign bodies were removed while 2 cases failed.Upper gastrointestinal tract perforation was closed by mental clip(n=12).One case of concurrent jejunal perforation was healed by fasting,antibiotics and intravenous nutrition.Three cases healed by nasogastric tube or nasal jejunal tube placement and another 3 children were operated.Among three surgical cases,one child developed esophageal stenosis at Month 3.One child of esophago-tracheal fistula caused by button battery died of acute pulmonary hemorrhage after removing battery at Day 5.Conclusion Magnetic foreign bodies and button batteries are common foreign bodies causing upper gastrointestinal tract perforation in children.Digestive endoscopy is a first choice for perforation caused by foreign bodies in upper gastrointestinal tract.Early diagnosis and intervention treatment may help to lower the occurrence of complications.More precautionary measures should be adopted for children.

关 键 词：食管穿孔 异物 胃镜 儿童 

分 类 号：R726.5[医药卫生—儿科]