本文選題：消化道異物　切入點：兒童　出處：《中國循證兒科雜志》2017年05期

【摘要】：目的總結(jié)兒童消化道異物特點和預(yù)后,為臨床治療和預(yù)后判斷提供依據(jù)和指導(dǎo)。方法回顧性收集廣東省廣州市婦女兒童醫(yī)療中心確診為消化道異物的病例,根據(jù)異物性質(zhì)和位置確定門診觀察和住院觀察取異物,建立資料采集表格,單人采集如下信息:年齡、異物類型、停留部位、誤吞時間、臨床癥狀、取異物地點、取異物方式、并發(fā)癥、異物去向。結(jié)果2006年5月至2016年10月1 257例消化道異物納入分析,男845例,平均(3.0±2.1)歲,誤吞異物時間(1.7±1.5)d。出現(xiàn)臨床癥狀266例(21.2%),其中上消化道癥狀210例(78.9%)。硬幣類異物比例最高(53.2%),其余為電池、磁鐵、長條/尖銳異物和不規(guī)則異物。就診時異物停留在胃內(nèi)最多見(40.8%)。自行排出異物者215例,時間(3.5±2.5)d。門診觀察806例中自行排出185例(23.0%);住院觀察治療451例中自行排出30例(6.6%),干預(yù)取出420例,其中食管鏡取出230例(54.8%),嘗試胃鏡取出169例(40.2%),外科手術(shù)取出21例(5.0%)。門診觀察和住院取異物病例中出現(xiàn)并發(fā)癥110例(8.8%),其中98例(86.4%)出現(xiàn)黏膜損害,2例食管異物因并發(fā)食管穿孔、主動脈食管瘺導(dǎo)致消化道出血死亡。以Logistic二元回歸對預(yù)后進(jìn)行危險因素分析顯示,臨床癥狀、停留部位、干預(yù)方式和異物類型是兒童消化道異物預(yù)后的獨立危險因素。長條/尖銳物的內(nèi)鏡干預(yù)率(49.2%)和臨床癥狀出現(xiàn)率(32.3%)均最高,磁鐵異物外科手術(shù)率(17.4%)最高,紐扣電池并發(fā)癥發(fā)生率(25%)最高;食道異物的內(nèi)鏡干預(yù)率(78%)、癥狀出現(xiàn)率(68.8%)和并發(fā)癥發(fā)生率(16.6%)均最高。結(jié)論兒童消化道異物類型多種多樣,預(yù)后與異物類型、停留部位、臨床癥狀和干預(yù)方式密切相關(guān)。
[Abstract]:Objective to summarize the characteristics and prognosis of digestive tract foreign bodies in children, and to provide basis and guidance for clinical treatment and prognosis.Methods the cases of foreign bodies in digestive tract diagnosed by Guangzhou Women's and Children's Medical Center in Guangdong Province were collected retrospectively. According to the nature and location of foreign bodies, the foreign bodies were selected for outpatient observation and inpatient observation, and the data collection forms were established.Single person collects the following information: age, type of foreign body, stay position, time of false swallowing, clinical symptoms, location of foreign body, ways of taking foreign body, complication, destination of foreign body.Results from May 2006 to October 2016, 1 257 cases of foreign bodies in digestive tract were included in the analysis. 845 cases were male (mean 3.0 鹵2.1) years old, and the time of ingesting foreign bodies by mistake was 1.7 鹵1.5 days.There were 266 cases with clinical symptoms, including 210 cases with upper digestive tract symptoms (78.9%).The proportion of coin type foreign bodies is the highest (53.2%), the rest are batteries, magnets, long / sharp foreign bodies and irregular foreign bodies.At the time of seeing a doctor, 40.8% of foreign bodies remained in the stomach.215 cases of foreign bodies were discharged by themselves, the time was 3.5 鹵2.5 days.Out of 806 cases, 185 cases were discharged by themselves, 30 out of 451 cases were treated by inpatient observation, and 420 cases were taken out by intervention. Among them, 230 cases were removed by esophagoscope, 169 cases by gastroscope, 169 cases by gastroscopy, and 21 cases by surgery.In the outpatient observation and hospitalization, there were 110 cases of complications, including 98 cases of mucosal damage, 2 cases of esophageal foreign bodies complicated with esophageal perforation, and 2 cases of aortic esophagoesophageal fistula leading to gastrointestinal bleeding death.The risk factors of prognosis were analyzed by Logistic binary regression analysis. The clinical symptoms, stay location, intervention methods and types of foreign bodies were independent risk factors for the prognosis of children's digestive tract foreign bodies.The rate of endoscopic intervention (49.2%) and the incidence of clinical symptoms (32.3%) were the highest, the rate of surgical operation of magnet foreign body (17.4%) was the highest, and the incidence of complications of button battery was 25% (P < 0.05).The endoscopic intervention rate of foreign body in esophagus was 78%, the incidence of symptoms was 68.8%, and the incidence of complications was 16.6%.Conclusion there are various types of foreign bodies in the digestive tract of children. The prognosis is closely related to the types of foreign bodies, the location of stay, the clinical symptoms and the ways of intervention.
【作者單位】： 廣東省廣州市婦女兒童醫(yī)療中心消化科;廣東省廣州市婦女兒童醫(yī)療中心放射科;
【分類號】：R725.7

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本文編號：1694618