儿童消化道异物1257例病例系列报告

A systemic report of 1 257 cases of ingested foreign bodies in children

目的总结儿童消化道异物特点和预后,为临床治疗和预后判断提供依据和指导。方法回顾性收集广东省广州市妇女儿童医疗中心确诊为消化道异物的病例,根据异物性质和位置确定门诊观察和住院观察取异物,建立资料采集表格,单人采集如下信息:年龄、异物类型、停留部位、误吞时间、临床症状、取异物地点、取异物方式、并发症、异物去向。结果2006年5月至2016年10月1 257例消化道异物纳入分析,男845例,平均(3.0±2.1)岁,误吞异物时间(1.7±1.5)d。出现临床症状266例(21.2%),其中上消化道症状210例(78.9%)。硬币类异物比例最高(53.2%),其余为电池、磁铁、长条/尖锐异物和不规则异物。就诊时异物停留在胃内最多见(40.8%)。自行排出异物者215例,时间(3.5±2.5)d。门诊观察806例中自行排出185例(23.0%);住院观察治疗451例中自行排出30例(6.6%),干预取出420例,其中食管镜取出230例(54.8%),尝试胃镜取出169例(40.2%),外科手术取出21例(5.0%)。门诊观察和住院取异物病例中出现并发症110例(8.8%),其中98例(86.4%)出现黏膜损害,2例食管异物因并发食管穿孔、主动脉食管瘘导致消化道出血死亡。以Logistic二元回归对预后进行危险因素分析显示,临床症状、停留部位、干预方式和异物类型是儿童消化道异物预后的独立危险因素。长条/尖锐物的内镜干预率(49.2%)和临床症状出现率(32.3%)均最高,磁铁异物外科手术率(17.4%)最高,纽扣电池并发症发生率(25%)最高;食道异物的内镜干预率(78%)、症状出现率(68.8%)和并发症发生率(16.6%)均最高。结论儿童消化道异物类型多种多样,预后与异物类型、停留部位、临床症状和干预方式密切相关。

Objective To summarize the characteristics and prognosis of digestive tract foreign body in children, thus toprovide basis and guidance for future clinical treatment. Methods A retrospective case？series analysis was carried out inGuangzhou Women and Children Medical Center. Patients should receive outpatient observation or hospitalization were determinedby the types and location of foreign body. The following information was collected by single person whith a data collection form： age,type and location of foreign body, time of swallowing, clinical symptoms, location of taking out the foreign body, treatment,complication and prognosis. Results A total of 1 257 cases of ingested foreign bodies in children were collected from May 2006 toOctober 2016, including 845 males, mean of age was 3.0±2.1 years, the time of swallowing was 1.7±1.5 days. Clinical symptomswere reported in 266 cases （21.2%）, and there were 210 cases of upper gastrointestinal symptoms （78.9%）. Coins were the mainproportion about 53.2%, and the rest were batteries, magnets, sharp and irregular foreign bodies. The foreign body staying in thestomach was most common symptom in the outpatient service （40.8%）. 215 cases of foreign bodies were discharged automatically,and mean of time was 3. 5 ± 2. 5 days. In 806 outpatient cases, 185 cases （ 23. 0%） were discharged automatically. In 451hospitalization patients, 30 cases were discharged automatically （6.6%）, 420 cases were discharged by intervention. 230 cases（54.8%） were taken out by esophagoscopy and 169 cases （40.2%） by gastroscope and 21 cases （5.0%） by surgical operation.There were 110 cases of complications occurred in outpatient and hospitalization （ 8. 8%）, among them there were 98 cases（86.4%）with mucosal damage, 2 cases with esophageal foreign body died because of gastrointestinal bleeding caused by thesimultaneous esophageal perforation and aortic esophageal fistula. Logistic binary regression was used to analyze the prognostic riskfactors. It showed that clinical symptoms, location and type of foreign body, treatment was independent risk factor for the prognosisof ingested foreign bodise in children. The incidence of endoscopic （49.2%） and clinical symptoms （32.3%） of long / sharp objects were the highest; The incidence of surgery of magnet was the highest （17.4%）; The incidence of complications of button batterieswas the highest （ 25%）; The incidence of endoscopic （ 78%） and clinical symptoms （ 68. 8%） and complications （ 16. 8%） ofesophageal foreign body were the highest.Conclusion The type of foreign body ingested in children is various, and its prognosis isclosely related to type and locations of foreign body, clinical symptoms and intervention methods.