上消化道异物内镜取出失败的相关因素分析

Impact factors of failure of removing upper gastrointestinal foreign bodies with endoscopy

目的分析上消化道异物内镜取出失败的相关因素。方法选取2002年1月-2012年12月在汕头市中心医院消化内镜中心接受治疗的上消化道异物患者,用Excel表格收集资料,包括异物种类、异物所滞留部位、异物吞入到就诊的时间、取异物术前相关检查、误吞异物人员构成、是否麻醉下手术、术中是否使用透明帽、手术医师年资。统计异物取出成功和失败例数,分析内镜下上消化道异物取出失败的影响因素。结果 367例患者中,成功取出上消化道异物346例,成功率为94.3%,取出失败21例,失败率为5.7%。经多因素Logistic回归分析,影响异物取出失败的相关因素有5项:金属异物、异物滞留食管、吞服异物>24 h、无术前检查、内镜无透明帽。结论金属异物、异物滞留食管、吞服异物>24 h、无术前检查、内镜无透明帽等是上消化道异物取出失败的独立影响因素。做好充分的术前准备、及时进行内镜手术、术中使用透明帽等是控制失败率的关键。

Objective To analyze the impact factors of failure of removing upper gastrointestinal foreign bodies with endoscopy. Methods Informations, including the types of foreign bodies, the stranded site, swallowing a foreign body to see a doctor, preoperative related check, foreign body ingestion personnel composition, anesthesia surgery, intraoper- ative whether to use transparent cap, the doctor qualification, success and failure cases were collected. The risk factors of failure of removing upper gastrointestinal foreign bodies with endoscopy were analyzed. Results 346 cases of upper gastrointestinal foreign bodies were successfully removed in 367 patients, the success rate was 94.3% , the failure rate was 5.7%. The multi-factor Logistic regression analysis showed there were five risk factors of the failure of foreign bodies removing： metal foreign bodies, foreign body retention of esophagus, swallowed foreign body 〉 24 h, no preoperative examination and without endoscopic transparent cap. Conclusion Metal foreign bodies, foreign body retention of esophagus, swallowed foreign body 〉 24 h, no preoperative examination, without endoscopic transparent cap are inde- pendent factors of the failure of upper gastrointestinal foreign bodies removing. To make sufficient preoperative prepara- tion, timely endoscopic surgery, intraoperative transparent cap are the key to control the failure rate.