内镜软性外套管在内镜下异物取出术中的治疗价值

The therapeutic value of the endoscopic management of ingested foreign bodies using an overtube

目的探讨内镜软性外套管在内镜下异物取出术中的价值。方法回顾性研究2005年1月至2013年12月首都医科大学附属北京安贞医院消化内镜中心收治的126例因怀疑有上消化道异物而行内镜检查的患者的治疗方式、并发症及治疗效果。结果126例中有39例接受了内镜软性外套管辅助下的内镜检查及治疗,全部成功取出异物(100%),1例出现食管黏膜损伤(2.56%);接受普通内镜检查和治疗的87例患者中,成功行异物取出术67例(77.01%),未能将异物经口取出20例(22.99%),其中将异物由食管推送入胃腔中4例,发生嵌顿未能取出13例,行外科手术治疗3例。这87例患者中有20例(22.99%)存在不同程度的食管上段黏膜的纵行损伤及出血。使用内镜软性外套管异物取出成功率为100%,并发症发生率为2.56%;未使用内镜软性外套管辅助而将异物取出成功率为77.01%,并发症发生率为22.99%,两组差异有显著性。结论内镜软性外套管在内镜下异物取出术中可以提高治疗的成功率,减少异物对食管上段黏膜的纵行损伤,降低并发症的发生。

Objective We discuss the therapeutic value of the endoscopic management of ingested foreign bodies u- sing an overtube. Method Retrospective study between January 2005 and December 2013, a total of 126 patients with suspected foreign bodies were admitted to Beijing An zhen Hospital endoscopy center. All patients underwent endoscopic procedure after admission. Endoscopic methods, complications and outcome were collected and ana- lyzed. Result There are 39 patients using overtube. The success rate for foreign-body removal was 100% （39/39）. There are 1 case with esophagus mucosa damage（2.56% ）. In other 87 patients with traditional method, the num- ber of successful cases for foreign bodies removal was 67（77.01% ）. There are still 20 patients（22.99% ） failed to remove foreign body through the mouth, 4 cases with foreign-body pushed into stomach, 13 cases for obstruction, and 3 patients with intervention of surgery. There are 20 cases with varying degrees of esophagus mucosa longitudi- nal damage and bleeding in 87 cases（22.99% ）. The rate of success and complications in the group of using over- tube were 100% and 2.56% respectively. In the group of no overtube the rate of success and complications were 77.01% and 22.99% respectively. There were significant differences between the two groups. Conclusion The en- doscopic management of ingested foreign-body using an overtube can improve the success rate of treatment, reduce the longitudinal damage in the upper esophagus mucous and the occurrence of complications. It is a safe, reliable and easy way to remove foreign-bodies.