易漏诊的上消化道异物九例临床分析

The Clinical Analysis of 9 Cases of Missed Diagnosis of Migrating Foreign Body in the Upper Digestive Tract

目的探讨易漏诊的上消化道异物的临床特征及可能出现的并发症及防范措施。方法对因上消化道异物漏诊致延迟取出9例的临床资料进行回顾性分析。结果本组均有异物误吞病史,病程12 h^21 d,异物为鱼刺7例,鸡骨2例。入院后经食管钡剂造影、纤维喉镜、胃镜、硬性食管镜等检查均未发现异物,后经CT检查明确异物位置。异物位于梨状窝4例,进入椎前筋膜、甲状腺、颈部间隙、食管壁肌层、环后壁黏膜下各1例,其中3例并发颈部间隙感染。4例梨状窝异物在全麻下经硬性食管镜取出,余5例在全麻下行颈侧切口取出异物,术后均痊愈出院。结论对于常规检查不能发现上消化道异物而有临床症状者,及时行CT检查不仅能够避免误漏诊及发现可疑的并发症,亦能帮助选择最佳治疗方法。

Objective To investigate the characteristics of the cases of foreign body in the upper digestive tract which often missed diagnosis,and the possible consequences and preventive method. Methods Retrospective analysis of 9 cases undergoing the delayed removal of foreign body in the upper digestive tract was carried out in our hospital. Results The cases of foreign body was fish（ 7 cases） or chicken bone（ 2 cases）,lasting 12 hours to 21 days. No foreign body was found by fiberopticlaryngoscope,gastroscope and esophageal barium meal radiography,except by MSCT. The foreign bodies were found migrating into pyriform sinus（ 4 cases）,prevertebral fascia（ 1 case）,thyroid（ 1 case）,neck soft tissue（ 1 case）,esophageal muscular（ 1 case）,pharyngeal mucosa（ 1 case）. 3 cases were complicated with neck space infection. 4 cases of foreign body in pyriform sinus were removed with the oesophagoscope,and 5 cases were taken out by an open approach,under general anesthesia. All were cured and discharged. Conclusion For migrating foreign bodies that miss diagnosis in regular examinations,MSCT is of immense value in avoiding missed diagnosis and misdiagnosis,and detecting possible complications and also can help doctors to choose the best possible approach.