游走性咽、颈段食管异物23例精准定位及成功治疗  

Accurate localization and successful treatment of 23 cases of migrating pharynx and cervical esophageal foreign bodies

作　　者：徐琼[1,2] 周水洪 王勤瑛[1] 鲍洋洋[1] 陈哲[1] 沈丽芳 戴利波[1] 刘永才[1] 程可佳[1] 李全成[1] Xu Qiong;Zhou Shuihong;Wang Qinying;Bao Yangyang;Chen Zhe;Shen Lifang;Dai Libo;Liu Yongcai;Cheng Kejia;Li Quancheng(Department of Otorhinolaryngology,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China;Department of Otorhinolaryngology,Hangzhou Future S&T City Hospital,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属第一医院耳鼻咽喉头颈外科,杭州310003 [2]杭州未来科技城医院耳鼻咽喉科,杭州310000

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第12期1206-1214,共9页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的总结游走性咽、颈段食管异物的临床特点以及诊断、定位、治疗方法。方法回顾性分析2015年1月至2020年3月浙江大学医学院附属第一医院耳鼻咽喉头颈外科收治游走性咽、颈段食管异物23例,男性9例,女性14例,年龄35~82(55.0±12.7)岁。异物摄入患者排除咽喉部异物后,均采取食管CT确诊食管异物,行多平面重建(multiplanar reconstruction,MPR),从水平位、冠状位、矢状位多个维度以及校正重建的MPR来定位异物的位置,根据异物位置,选择合适的手术方法,记录患者症状、并发症、异物种类、定位和手术方法以及相关信息,采用描述性方法和SPSS 25.0软件分析相关数据。结果游走性食管异物23例的临床症状表现包括咽痛(20/23)、异物感(6/23)、声嘶(1/23)、转颈受限(1/23)、张口受限(1/23)等局部症状,也有发热(7/23)、纳差(1/23)、腹痛(1/23)等全身症状。异物种类为19例鱼刺,2例金属丝,1例绣花针,1例鸡骨。其中颈段食管腔外的游走异物为9例(39.1%);颈段食管肌肉层异物2例(8.7%);咽部游走异物12例(52.2%)。23例患者行颈侧切开取出异物21例,其中直接定位颈侧切开取出异物11例,MPR和/或校正MPR准确定位腔外异物后第二次颈侧切开取出异物10例,准确定位后支撑喉镜咽后壁黏膜切开异物取出1例,准确定位后气管镜异物取出1例。游走异物患者(n=23)与同期就诊的腔内异物患者(n=308)相比,摄入鱼刺[19(82.6%,19/23)vs.133(43.2%,133/308),OR=7.31]、首次就诊时间超过24 h[20(87.0%,20/23)vs.77(25.0%,77/308),OR=17.20]是食管异物游走至食管外的重要危险因素(P值均<0.05)。结论CT多平面重建能精确定位游走性咽、颈段食管异物,给医生提供更直观的影像学证据,为手术方案的制订提供影像基础。咽、颈段食管异物需要及早处理,否则容易发生游走,导致严重并发症。Objective To explore clinical features,diagnosis,localization,and therapeutic strategy of migratory pharyngeal and cervical esophageal foreign bodies.Methods A total 23 cases of pharyngeal and cervical esophageal migratory foreign bodies were admitted between January 2015 and December 2021.There were 14 females and 9 males with the age ranged from 35 to 82(55.0±12.7)years.In all the cases,esophageal CT was taken to confirm the esophageal foreign body.Multiplanar reconstruction(MPR)was performed to locate the foreign body from the horizontal,coronal and sagittal dimensions as well as the corrected reconstructed MPR.According to the location of the foreign body,appropriate surgical method was selected.The symptoms,complications,types of foreign body,positioning,surgical methods,and relevant information were recorded.Data were analyzed using the descriptive method and SPSS 25.0 software.Results The clinical symptoms of 23 migrating esophageal foreign bodies included pharyngodynia(20/23),foreign body sensation(6/23),hoarsenss(1/23),difficulty in turning neck(1/23),difficulty in opening mouth(1/23),fever(7/23),poor appetite(1/23),and abdominal pain(1/23).The foreign bodies included 19 fish bones,2 wires,1 embroidery needle and 1 chicken bone.There were 9 cases(39.1%)of foreign bodies located in extraluminal cervical esophagus,2 cases(8.7%)of foreign bodies located in the muscular layer of the cervical esophagus and 12 cases(52.2%)of foreign bodies located in pharynx.Twenty-one cases of foreign bodies were removed by cervical lateral incision,in which 11 were removed by cervical lateral incision directly,10 by the second lateral cervical incision after the foreign bodies were accurately located by MPR and/or corrected MPR,1 foreign body was removed by incision of the pharyngeal mucosa under suspension laryngoscope,1 foreign body was removed by tracheoscopy.Compared with patients with intraluminal foreign bodies(n=308)treated in the same period,intake of fishbone[19(19/23)vs.133(82.6%(43.2%,133/308),OR=7.31]and first v

关 键 词：咽异物 食管异物 游走性异物 CT多平面重建 定位 并发症 治疗 

分 类 号：R768.32[医药卫生—耳鼻咽喉科]