儿童和青少年误吞磁性异物致消化道损伤的文献分析

Systematic review of gastrointestinal injury caused by magnetic foreign body ingestions in children and adolescence

目的研究儿童误吞磁性异物致消化道损伤的诊断及处理措施。方法通过Google、Medline、ISIWebofKnowledge、0vid、万方、维普、CNKI、学位论文、会议论文数据库及申请文献传递等方式收集1987年6月至2010年4月国内外所有以英文、中文、日文和韩文发表的关于误吞磁性异物而导致相应消化道并发症的文献。研究内容包括发病年龄、性别、国家和地区分布、磁性异物的数量、磁性异物来源、临床表现、诊断及取除异物的方法等。结果共收集了来自17个国家和地区的98例吞咽磁性异物病例。其中18岁以下未成年人94例．5岁以下儿童占62．2％（61／98）．高发年龄为3岁（16．3％，16／98）。所吞咽的磁性异物来源玩具73例（74．5％），医疗仪器8例（8．2％），饰品4例（4．1％），其他13例（6．2％）：异物数量2-100枚．其中11例（11．2％）伴有异食癖或孤癖症等精神症状。所有病例均存在不同程度延误诊治的情况．其中1例因严重感染而死亡。开腹探查发现．消化道损伤包括从食管至结肠不同部位的穿孔和肠瘘，其中小肠损伤占51．0％，其次是小肠．结肠瘘占15．3％。除2例患儿急诊经内镜取除异物外．其余患儿行肠切除吻合术和肠瘘修补术。结论2枚以上的磁性异物会导致严重消化道损伤．需要早期明确诊断并手术治疗。对5岁以下儿童需要更多的预防措施。

Objective To study the diagnosis and treatment of gastrointestinal injury caused by magnetic foreign body ingestions in children. Methods A literature search was performed to identify all the studies related to gastrointestinal tract injury caused by ingesting magnetic foreign body using databases including Google, Medline, ISI Web of Knowledge, Ovid, Wanfang data, VIP, CNKI, degree dissertation, meeting abstracts, and request for document delivery. Language was limited to English, Chinese, Japanese, and Korean. Parameters studies were age at diagnosis, gender, country, regional distribution, number of magnetic foreign bodies, source of magnetic foreign bodies, clinical features, diagnosis, and method for foreign body removal. Results A total of 98 cases of magnet ingestion were identified from 17 countries and regions. There were 94 patients under the age of 18, with most children younger than 5 years old（62.2%,61/98）. The age at peak incidence was 3 years old （16.3%, 16/98）. Magnetic foreign bodies ingested included toys （74.5%）, medical apparatus （8.2%）, accessories（4.1%）, and others（6.2%）. The number of bodies ranged from 2 to 100. Eleven （11.2%） patients were complicated with allotriophagia or autism. Delay diagnosis and treatment existed in all the patients to varying extents, of whom one died from severe infection. Exploratory laprotomy showed a wide range of bowel damage from the esophagus to the colon, including perforation and intestinal fistula. Intestinal damage was the most common injury （51.0%）, followed by intestine-colon fistula （15.3%）. All the patients required bowel resection with anastomosis or fistula repair except for 2 children who were managed by endoscopic removal of the foreign bodies. Conclusion Ingesting more than one magnet will lead to severe gastrointestinal injury. Early diagnosis and surgical intervention are important. More precautious measures should be taken for children aged younger than 5 years old.