儿童纽扣电池食管异物临床治疗

Clinical experience in the treatment of esophageal foreign body with button battery in children

目的分析儿童纽扣电池食管异物临床诊断、治疗及预后特征,为纽扣电池类食管异物临床处理提供参考。方法选取本院2016年4月～2018年5月收治的341例食管异物中8例纽扣电池食管异物的患儿,结合纽扣电池大小、嵌顿时间、术中食管黏膜损伤情况及预后,综合分析纽扣电池类食管异物的临床特征。结果 8例患儿均为学龄前儿童;最短异物嵌顿时间3小时20分钟,最长243小时35分钟;7例异物位于食管第一狭窄,1例位于食管第二狭窄;食管黏膜轻度充血水肿1例;黏膜明显烧伤4例;食管狭窄,可疑穿孔1例;食管穿孔1例;气管食管瘘1例。术后胃肠减压最短3天,最长12天,1例气管食管瘘予空肠营养127天后治愈。结论儿童纽扣电池类食管异物需急诊手术取出,门急诊需警惕纽扣电池类食管异物;术中需仔细检查食管黏膜损伤情况,并彻底清洗创面;术后并发症种类较多,需密切观察和积极对症治疗。

OBJECTIVE To analyze the routine diagnosis,treatment and prognosis of button cell esophageal foreign body in children,so as to provide reference for clinical treatment of button cell esophagus foreign body. METHODS In our hospital from April 2016to May 2018, the clinical data of 8children with button cell esophageal foreign body from 341esophageal foreign bodies were studied.The clinical characteristics of button cell esophageal foreign bodies were analyzed in combination with the size of button cells,the time of foreign body lodged,the damage of esophagus mucosa and the prognosis.RESULTS All the 8patients were preschool children.The shortest foreign body lodged time was 3hours 20minutes,the longest time was 243hours and 35minutes.The foreign body in 7cases were located in the first stenosis of the esophagus,1case in the second stenosis of the esophagus,1case with mild hyperemia and edema in the esophageal mucosa,4cases with severe burns,1case with esophageal stenosis and suspected perforation,1case with perforation of esophagus and 1case with tracheoesophageal fistula.The shortest postoperative gastrointestinal decompression was 3days, the longest was 12days.1case with tracheoesophageal fistula were cured after 127days of jejunal nutrition. CONCLUSION Children with button cell esophageal foreign bodies need to be removed by emergency operation. There are many kinds of complications during and after operation.Close observation and positive symptomatic treatment are needed.