儿童食管异物致食管穿孔的诊断及处理

Diagnosis and treatment of esophageal perforation induced by esophageal foreign body in children

目的:探讨儿童复杂食管异物致食管穿孔的诊断及治疗方法。方法:回顾性分析10例食管异物致食管穿孔患儿的资料,1例异物为纽扣电池的患儿为外院取出异物后转入我院;7例患儿经硬性食管镜下取异物;1例患儿因异物由食管突入气管内,经气管切开取异物;1例患儿因食管周围脓肿就诊,术中检查食管穿孔,术中未发现明确异物,术后于ICU抗炎治疗时经口吐出一玻璃片异物。结果:10例患儿中,异物分别为枣核3例、纽扣电池2例、金属齿轮1例、别针1例、易拉罐金属拉环1例、玻璃片1例、弧形硬塑料片1例。7例患儿经保守治疗后食管穿孔痊愈,恢复正常饮食;3例患儿行气管食管瘘修补手术后恢复正常饮食。结论:食管异物手术中如异物嵌顿时间长、异物形状尖锐或有腐蚀性,需高度怀疑食管穿孔可能。术后禁食禁水并行食管造影明确诊断。对于已确诊食管穿孔的患儿,需积极抗炎,密切随诊,穿孔较小者经鼻饲治疗一段时间后多可自愈;对已形成气管食管瘘的穿孔,需待患儿身体条件允许后择期行修补手术。

Objective：To discuss the diagnosis and treatment of esophageal perforation induced by esophageal foreign body. Method：Ten patients, who were diagnosed as esophageal foreign body and esophageal perforation, were retrospectively analyzed. One patient was operated in other hospital and transferred to our department post- operation. The foreign bodies were removed through rigid esophagoscope in 7 cases and through the tracheotomy in 1 case. The last case was admitted into hospital for abscess around the esophagus. The foreign body wasn＇t find during the examination of rigid esophagoscope and the patient vomited out a glass foreign body after the surgery. Result：In allcases, there were three date stones, two button batteries, one metal gear, one pin, one metal cans pull ring, one glass plate, one arc hard plastic sheet. Seven patients were cured after conservative treatment, and re- stored normal diet. For the rest 3 cases, patients were cured after the repair operation of traeheoesophageal fistula. Conclusion：The esophageal perforation must be highly suspected of the esophageal foreign body with a long history, sharp shape or corrosive foreign body. The esophageal radiography may be taken to obtain the final diagnosis. The patients diagnosed as esophageal perforation must be treated with antibiotics, nasal feeding or feeding by gastrostomy, and followed-up closely. Small perforation can heal after a period of time by nasal feeding, while tra- cheoesophageal fistula was needed to repaire after a period of time for restoring a good physical condition in most eases.