婴幼儿复杂食管异物诊治分析

Analysis of complicated esophageal foreign bodies in infants

目的探讨婴幼儿复杂食管异物的诊治经验。方法回顾性分析我院耳鼻咽喉科2002年1月～2010年12月70例复杂婴幼儿食管异物的临床资料,所有病例均行全麻硬性食管镜下异物取出术,5例术中应用Hopkin's潜窥镜。其中异物为纽扣电池者6例,同时合并有食管瘢痕者10例,对2例食管异物取出术后出血者,局部填塞速即纱(SURGICEL)止血。结果 70例患儿中,97.1%(68/70)经全麻气管插管麻醉硬性食管镜下,将异物顺利取出,其中2例异物取出后,并发食管黏膜出血,局部填塞速即纱成功止血;2.9%(2/70)颈侧切开取出异物;所有病例顺利治愈。结论婴幼儿复杂食管异物,确诊后尽早手术;全身麻醉是确保尖锐复杂异物成功取出的关键及安全保障。要特别重视纽扣电池等腐蚀性异物,术后延长禁食时间,保留鼻饲管1周左右。术中应用Hopkin's潜窥镜,能安全有效的取出异物、预防并发症的发生;速即纱应用于食管内止血是简便可行的。

OBJECTIVE To discuss the experience in the diagnosis and management of complicated esophageal foreign bodies in infants.METHODSA retrospective study was conducted in 70 infants with complicated esophageal foreign bodies from January2002 to December 2010 in our hospital.Endoscopies in general anesthesia intubation were performed in all cases,Application of Hopkins rod-lens were performed in 5 cases.The foreign bodies were button batteries in 6 cases,Ten patients also had esophageal stenosis.After removal of the foreign body,esophageal mucosal bleeding occurred in 2 cases,and were stopped by packing of the SURGICEL.RESULTS Endoscopies in general anesthesia intubation were performed in removal of foreign bodies in 68 infants（68/70,97.1%）,and incision of neck and esophagotomy were performed in 2 cases（2/70,2.9%）.All the patients were cured successfully.CONCLUSION For complicated esophageal foreign bodies in infants,once diagnosed,surgery should be done as soon as possible.A thorough understanding of medical history and the types of foreign bodies was important before surgery.General anesthesia is the key to remove the sharp or complicated foreign bodies.If the foreign body is corrosive materials,such as a button battery,we should take more attention,extend fasting time after surgery,keep nasogastric tube for about one week.Application of Hopkins rod-lens is essential to remove the difficult esophageal foreign bodies and prevent complications.Application of SURGICEL to stop bleeding in esophagus is simple and feasible.