小儿吞食多枚磁性异物的临床特点及诊治体会  

Clinical characteristics and diagnosis and treatment experience of multiple magnet ingestion in children

作　　者：李德宇[1] 孙俊[2] 赵健[1] 徐伟珏[2] LI De-yu;SUN Jun;ZHAO Jian(Department of Pediatric Surgery,Yangzhou Maternal and Child Health Care Hospital,Affiliated Hospital of Medical College of Yangzhou University,Yangzhou 225002,China)

机构地区：[1]扬州市妇幼保健院小儿外科,扬州大学医学院附属医院,225002 [2]上海市儿童医院,上海交通大学附属儿童医院普通外科,200062

出　　处：《中国实用医药》2022年第24期86-89,共4页China Practical Medicine

摘　　要：目的分析小儿吞食多枚磁性异物的临床特点,探讨最佳治疗方案。方法回顾性分析29例吞食多枚磁性异物患儿的临床资料,分析治疗方法及预后。结果患儿年龄8个月~12岁7个月,平均年龄(64.38±37.91)个月。其中1~4岁及7~10岁为两高发年龄段;19例家庭吞食,10例学校吞食;23例磁性异物来源于玩具(其中21例为巴克球),6例来源于含磁铁家庭日用品;吞食磁性异物中位个数5(2,27)枚。15例伴消化道损伤,最常见症状是腹痛(11例,73.3%),最常见的腹部体征是腹部压痛(6例,40.0%),C反应蛋白(CRP)>5 mg/L 8例(53.3%),白细胞计数(WBC)>10×10^(9)/L 7例(46.7%),腹部摄片提示存在不完全性肠梗阻4例(26.7%),腹部立位片提示明显盆腔积液3例(20.0%)。7例(24.1%)患儿胃镜下取出,其中3例磁性异物钳夹胃壁组织(2例贲门,1例胃角);9例(31.0%)患儿自行排出,平均吞食至排出时间(63.11±44.53)h;13例(44.8%)患儿手术取出,其中腹腔镜手术9例(4例中转开腹),开腹手术4例,手术时间(151.92±44.82)min,术后禁食时间(4.77±0.73)d,术后住院时间(8.23±1.42)d,所有患儿均顺利出院,1例术后出现粘连性肠梗阻,经保守治疗好转。结论小儿误食多枚磁性异物后可能导致胃肠道多发损伤,应尽早于胃镜下取出。如已进入小肠,出现腹痛、呕吐、腹部压痛,X线摄片提示不完全性肠梗阻、盆腔积液或连续摄片磁性异物位置固定,应及时手术治疗。Objective To analyze the clinical characteristics of multiple magnetic ingestion in children,and discuss the best treatment regimen.Methods The clinical data of 29 children with multiple magnet ingestion were retrospectively analyzed,and the treatment methods and prognosis were analyzed.Results The age of the children ranged 8 months-12 years and 7 months,with a mean age of(64.38±37.91)months.Among them,1-4 years old and 7-10 years old are the two high-risk age groups;19 children ingested multiple magnets at home,and 10 children ingested at school.23 children's(79.3%)magnets were from toys(Buck balls in 21 cases),and 6 children's(20.7%)were from daily utensils,with a median number of 5(range 2-27)magnets.15 cases had gastrointestinal injury,and abdominal pain was the most common symptom with abdominal tenderness as the most common sign,C-reactive protein(CRP)>5 mg/L in 8 cases(53.3%),white blood cell count(WBC)>10×10^(9)/L in 7 cases(46.7%),abdominal radiographs suggested the presence of incomplete intestinal obstruction in 4 cases(26.7%),and abdominal upright radiographs showed obvious pelvic effusion in 3 cases(20.0%).7 children(24.1%)were removed gastroscopically,including 3 cases of magnetic clamping of gastric wall tissues(2 cardia,1 gastric horn);9(31.0%)children expelled themselves,with an average ingestion to expulsion time of(63.11±44.53)h.13 children(44.8%)were removed surgically,including 9 cases of laparoscopic surgery(4 cases were converted to open surgery)and 4 cases of open surgery,with an operation time of(151.92±44.82)min,a postoperative fasting time of(4.77±0.73)d,and a postoperative hospital stay of(8.23±1.42)d.All children were discharged successfully,and 1 case developed postoperative adhesive intestinal obstruction,which improved with conservative treatment.Conclusion The accidental ingestion of multiple magnet in children may lead to multiple injuries of the gastrointestinal tract,which should be removed under gastroscope as soon as possible.If it has entered the small intestine,abdom

关 键 词：多枚磁性异物 胃肠道损伤 小儿 临床特点 诊治 

分 类 号：R726[医药卫生—儿科]