本文選題：異物嵌頓　切入點：食管　出處：《浙江大學》2017年碩士論文

【摘要】：目的探討食管異物嵌頓的臨床特征,并分析內鏡取食管異物成功率的影響因素,以及異物嵌頓后并發(fā)癥發(fā)生的相關因素。方法2015年10月至2016年8月,收集浙江省內共10個地市18所醫(yī)院因懷疑食管異物嵌頓至內鏡中心就診的所有病例。利用統(tǒng)一的調查問卷,分別收集一般資料(包括性別、年齡)、臨床檢查特征(包括相關疾病史、臨床表現、影像學表現)以及內鏡治療相關資料(包括異物種類、大小、位置、內鏡治療輔助器械等),并統(tǒng)計分析食管異物嵌頓后并發(fā)癥及其發(fā)生的相關因素,以及內鏡取食管異物成功率及其影響因素。結果(1)納入595例因可疑食管異物嵌頓而就診的患者,平均年齡51.7±20.1歲。其中男性278例,女性317例。(2)最常見的主要異物種類分別為魚刺(34.0%)、禽類骨(22.1%)、棗核(17.1%)和軟性食物團塊(14.6%)。其中大部分為短異物(2.5cm,74.0%),其次為中型異物(2.5～6.0cm,24.5%)和長異物(6cm,1.5%)。異物通常最容易嵌頓在食管上段(75.9%),其次為中段(15.2%)和下段(8.9%)。(3)96.3%的患者出現明顯的臨床癥狀,上段食管異物(98.1%)較遠段食管異物(92.6%)更易出現臨床癥狀(p0.001),而患者年齡、性別、異物種類與臨床癥狀無明顯相關性(p0.05)。(4)內鏡取異物率達94.5%。靜脈麻醉內鏡(99.3%)較普通內鏡(92.7%)有較高取異物成功率(p0.01);而年齡、異物滯留時間、嵌頓位置、異物是否尖銳、異物大小等因素均與取異物成功率不相關(p0.05)。(5)異物嵌頓后并發(fā)癥發(fā)生率達34.0%。主要并發(fā)癥包括滲血(12.3%)、黏膜糜爛(10.8%)、黏膜撕裂(9.1%)和黏膜潰瘍(6.6%)等。5.6%患者發(fā)生食管穿孔事件。異物在食管滯留時間延長可增加并發(fā)癥的發(fā)生風險(p0.001)。對比在12h內,滯留時間超過24h,并發(fā)癥發(fā)生率提高2.2倍;滯留超過48h,并發(fā)癥發(fā)生率提高6.2倍。Logistic回歸分析提示尖銳異物相對非尖銳異物,并發(fā)癥發(fā)生率顯著升高(OR=3.36,95%CI:1.97-5.74,p0.001)。異物大小、異物嵌頓位置不是并發(fā)癥發(fā)生的影響因素(p0.05)。穿孔發(fā)生率與異物滯留時間、異物是否尖銳呈顯著相關(p0.01),而與嵌頓位置、異物大小不相關(p0.05)。異物滯留超過24小時和72小時后相對于12小時內的穿孔發(fā)生率顯著提高13.4倍和31.1倍(p0.01)。結論(1)內鏡治療食管異物嵌頓具有較高成功率和安全性。(2)靜脈麻醉可以提高內鏡治療食管異物成功率。(3)對于尖銳異物,應盡早在24小時內移除,以降低異物引起的嚴重并發(fā)癥如穿孔。
[Abstract]:Objective to investigate the clinical features of esophageal foreign body incarceration, and to analyze the factors influencing the success rate of endoscopic foreign body extraction and the related factors of complications after foreign body incarceration. Methods from October 2015 to August 2016, A total of 18 hospitals in 10 prefectures and cities in Zhejiang province were collected for suspected esophageal foreign body incarceration to the endoscopic center. General data (including gender) were collected using a unified questionnaire. Age, clinical features (including history, clinical manifestations, imaging findings) and endoscopic treatment-related data (including types, size, location of foreign bodies), The complications after esophageal foreign body incarceration, the related factors, the success rate of endoscopic foreign body extraction and its influencing factors were statistically analyzed. Results 595 patients with suspected esophageal foreign body incarceration were included in the study. The average age was 51.7 鹵20.1 years old. The most common types of foreign bodies in 317 female cases were fish prickly (34.0), poultry bone (22.1g), jujube (17.1g) and soft food lumps (14.6m), most of which were short foreign bodies (2.5cm / 74.0), followed by medium-sized foreign bodies (2.56.0cm / 24.5cm) and long foreign bodies (6cm / 1.5cm). 75.9% of the patients in the upper segment, followed by 15.2% in the middle segment, and 8.9% in the lower segment showed obvious clinical symptoms. Upper esophageal foreign body (98.1) and distal esophageal foreign body (92.6%) are more likely to appear clinical symptoms (p 0.001), and the patient's age, sex, There was no significant correlation between foreign body types and clinical symptoms (P 0.05). The rate of foreign body extraction by endoscopy was 94.5. the rate of foreign body extraction by intravenous anesthesia was 99.3) was higher than that by common endoscopy (P 0.01), but age, foreign body retention time, place of incarceration, and whether the foreign body was sharp or not were higher than those of common endoscope (P < 0.05). The incidence of complications after foreign body incarceration was 34.00.The main complications included bleeding 12.3i, mucosal erosion 10.8T, mucosal tear 9.1g) and mucosal ulcer 6.6cm).) the incidence of esophageal perforation occurred in 5.6% of the patients. Prolonged foreign body retention in the esophagus increased the risk of complications (P 0.001). The incidence of complications increased by 2.2 times over 24 hours and 6.2 times by logistic regression analysis. Logistic regression analysis showed that the incidence of acute foreign bodies was significantly higher than that of non-sharp foreign bodies, and the incidence of complications was significantly increased by 3.3695% CI: 1.97-5.74g, p 0.0010.The size of foreign bodies was significantly higher than that of non-sharp foreign bodies. The incidence of perforation was significantly correlated with the retention time of the foreign body, and there was a significant correlation between the incidence of perforation and the retention time of the foreign body, while the incidence of perforation was significantly correlated with the location of the foreign body, while the incidence of perforation was significantly correlated with the retention time of the foreign body. The incidence of foreign body perforation after 24 hours and 72 hours of foreign body retention was significantly increased by 13.4 times and 31.1 times than within 12 hours. Conclusion the endoscopic treatment of esophageal foreign body incarceration has a higher success rate and safety. Intravenous anesthesia can improve the success rate of endoscopic treatment of esophageal foreign bodies. Remove within 24 hours as early as possible to reduce serious complications such as perforation caused by foreign bodies.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R768.32
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本文編號：1684518