上消化道异物2 619例内镜诊治分析  

Endoscopic diagnosis and treatment of foreign bodies in the upper gastrointestinal tract: an analysis of 2 619 cases

作　　者：侯叶廷[1] 张铭麟 史伟东[2] 孟根珠 拉梁雄 魏云[5] 张浩然[6] 卢玉杰 刘晓红 王珏 宋建忠[1] 杜春[1] 王丽萍[1] 陈平[1] Hou Yeting;Zhang Minglin;Shi Weidong;Meng Genzhula;Liang Xiong;Wei Yun;Zhang Haoran;Lu Yujie;Liu Xiaohong;Wang Jue;Song Jianzhong;Du Chun;Wang Liping;Chen Ping(Department of Gastroenterology,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010000,China;Department of Gastroenterology,Hohhot First Hospital,Hohhot 010000,China;First Department of Geriatrics,Xilin Gol Central Hospital,Xilin Gol 026000,China;Gastroenterology Endoscopy Center,Inner Mongolia Autonomous Region People′s Hospital,Hohhot 010000,China;Department of Gastroenterology,Baotou Central Hospital,Baotou 014000,China;Endoscopy Center,Chifeng City Hospital,Chifeng 024000,China;Department of Gastroenterology,Bayan Nur Central Hospital,Bayan Nur 015000,China)

机构地区：[1]内蒙古医科大学附属医院消化内科,呼和浩特010000 [2]呼和浩特市第一医院消化内科,呼和浩特010000 [3]锡林郭勒盟中心医院老年医学一科,锡林郭勒026000 [4]内蒙古自治区人民医院消化内镜中心,呼和浩特010000 [5]包头市中心医院消化内科,包头014000 [6]赤峰市医院内镜诊疗中心,赤峰024000 [7]巴彦淖尔市医院消化内科,巴彦淖尔015000

出　　处：《中华全科医师杂志》2024年第5期469-474,共6页Chinese Journal of General Practitioners

基　　金：内蒙古自治区高等学校科学研究项目(NJZZ22657);内蒙古自治区卫生健康科技计划项目(202201259)。

摘　　要：目的探讨内蒙古自治区上消化道异物内镜治疗的成功率、并发症及相关影响因素。方法回顾性分析2017年1月至2021年12月内蒙古自治区7家大型三级综合医院收治的2619例门急诊及住院的上消化道异物患者临床资料,包括年龄、性别、基础疾病、症状、病程、异物种类、嵌顿部位、嵌顿时间、并发症、治疗等情况,并分析发生并发症的影响因素。结果2619例上消化道异物患者中,男性1050例(40.09%),女性1569例(59.91%)。年龄2~93岁,≥60岁者1439例(54.95%)。合并基础疾病者413例(15.77%),其中,脑血管疾病91例(3.47%)、心血管疾病86例(3.28%)、慢性阻塞性肺疾病77例(2.94%)、食管狭窄101例(3.86%)、痴呆及精神类疾病28例(1.07%)。最显著的症状为咽部异物感及咽部疼痛1494例(57.04%)。最常见的异物种类为枣核,占74.57%(1953/2619),其次是骨头、义齿和鱼刺,分别占7.22%(189/2619)、7.10%(186/2619)和5.15%(135/2619)。最常见的异物嵌顿部位为食管入口及上段,占71.55%(1874/2619)。2437例(93.05%)患者的异物经胃镜成功取出。2619例患者中,发生并发症者804例(30.70%)。年龄≥60岁(OR=1.970,95%CI:1.656~2.342)、有基础疾病(OR=3.989,95%CI:3.210~4.959)、尖锐异物(OR=1.994,95%CI:1.367~2.908)、异物嵌顿时间≥24 h(OR=7.488,95%CI:6.189~9.058)是并发症发生的影响因素(均P<0.05)。结论内蒙古地区上消化道异物胃镜取出成功率高,安全性高。应特别关注高龄、有基础疾病、尖锐异物、异物嵌顿时间≥24 h的患者,以减少并发症发生。Objective To analyse the success rate,complications and related risk factors of endoscopic treatment of upper gastrointestinal foreign bodies.Methods The clinical data of 2619 patients with upper gastrointestinal foreign bodies who underwent endoscopic diagnosis and treatment in 7 tertiary general hospitals in the Inner Mongolia Autonomous Region from January 2017 to December 2021 were retrospectively analyzed.Results Among 2619 cases there were 1050(40.09%)males and 1569(59.91%)were females aged from 2 to 93 years old,and 1439 cases(54.95%)were older than 60 years.Comorbid diseases were present in 413 cases(15.77%),including 91 cases(3.47%)of cerebrovascular diseases,86(3.28%)cases of cardiovascular diseases,77(2.94%)cases of chronic obstructive pulmonary diseases,101(3.86%)cases of esophageal strictures,28(1.07%)cases of dementia and psychiatric diseases.The most common symptom was foreign body sensation in the throat and throat pain(57.04%,n=1494).The most common foreign body was date kernels(74.57%,n=1953),followed by animal bones,denture and fish spines(7.22%,n=189,7.10%,n=186 and 5.15%,n=135,respectively).The entrance and upper part of the esophagus were the most common sites of foreign body incarceration,accounting for 71.55%(n=1874).The upper gastrointestinal foreign bodies were successfully removed in 2437 patients(93.05%).The complications occurred in 804 patients(30.70%).The advanced age(≥60 years)(OR=1.970,95%CI:1.656-2.342),comorbid diseases(OR=3.989,95%CI:3.210-4.959),sharp foreign bodies(OR=1.994,95%CI:1.367-2.908),and incarceration time≥24 h(OR=7.488,95%CI:6.189-9.058)were risk factors for complications(all P<0.05).Conclusions The success rate and safety of gastroscopic removal of foreign bodies in the upper gastrointestinal tract are generally high.To reduce complications special attention should be paid to patients with advanced age,comorbid diseases,sharp foreign bodies,and longer incarceration time.

关 键 词：异物 胃镜 上消化道 并发症 影响因素 

分 类 号：R57[医药卫生—消化系统]