食管异物临床特点及规范化诊疗

Clinical features and standardized diagnosis and treatment of esophageal foreign bodies

目的总结郑州大学第一附属医院食管异物的临床特点,探讨食管异物规范化诊疗方案.方法收集郑州大学第一附属医院2011-07/2017-07年间收治确诊为食管异物住院的1190例患者,对其性别、年龄、首诊科室、就诊时间、异物种类、嵌顿部位、治疗方案及住院日等资料进行整理回顾性分析.结果1190例资料中男568例,女622例,男女比例1.0∶1.1;年龄2 mo-99岁,平均45岁±28.44岁,中位年龄54岁,<15岁的293例(24.6%),15-55岁的293例(24.6%),>55岁的604例(50.8%);首诊科室为咽喉头颈外科966例(81.2%),消化内科138例(11.6%),胸外科46例(3.4%),其他科室40例(3.4%);其中24 h内就诊者716例(60.2%),24-72 h内126例(10.6%),>72 h的共348例(29.2%);异物中植物类448例(37.6%),动物类403例(33.9%),金属类200例(16.8%),合成类139例(11.7%),其中枣核、鸡骨、硬币占总数的六成(750例,62.9%);嵌顿部位位于食管入口附近的共827例(69.5%),食管上段245例(20.6%),中下段94例(7.8%),其他25例(2.1%);经内镜治疗1088例(91.4%),手术治疗41例(3.4%);住院日中位数为5 d,最短1 d,最长71 d,平均住院日5.9 d±4.9 d.结论食管入口处附近为异物为异物最易嵌顿部位.遵循诊断三要素和治疗四规范的诊疗方案,尽可能24 h内取出异物,及时纠正水电解质紊乱、有效抗感染、高营养支持,必要时暂时性食管旷置,方能使患者得到最佳的预后.

AIM To summarize the clinical characteristics of esophageal foreign bodies and to explore their standardized diagnosis and treatment.METHODS This retrospective study was conducted at our hospital from July 2011 to July 2017, and we reviewed the clinical data for 1190 patients with esophageal foreign bodies with regard to their sex, age, department patients first visited, treatment time, type, incarcerated site, treatment plan, and length of hospital stay.RESULTS Of 1190 patients included, 568 were male and 622 were female, with a male-to-female ratio of 1.0∶1.1. They aged from 2 mo to 99 years（mean, 45 years ± 28.44 years）, with a median age of 54 years; 293（24.6%） patients were under 15 years, 293（24.6%） were between 15 and 55 years, and 604（50.8%） over 55 years. Otolaryngology and head surgery department was the most first-v isited department（966, 81.2%）, followed by gastroenterology department（138, 11.6%）, thoracic surgery department（46, 3.4%）, and others（40, 3.4%）. There were 716（60.2%） patients who visited hospital within 24 h, 126（10.6%） in 24 to 72 h, and 348（29.2%） over 72 h. The foreign bodies were plant-based in 448（37.6%） patients,animal-based in 403（33.9%）, metallic in 200（16.8%）, and composite material-based in 139（11.7%）, with jujube pits, chicken bones, and coins accounting for 62.9%（750 patients） of all cases. The foreign bodies were most commonly located in the upper orifice of the esophagus（827, 69.5%）, followed by the upper part（245, 20.6%）, the middle and lower parts（94, 7.8%）, and others（25, 2.1%）. We treated 1088（91.4%） patients by endoscopy and 41（3.4%） by surgery. The duration of hospitalization ranged from 1 to 71 d（median, 5 d; mean, 5.9 d ± 4.9 d）.CONCLUSION Esophageal foreign bodies most commonly occur in the upper orifice of the esophagus. Standardized diagnosis and treatment are important. Esophageal foreign bodies should be taken out within 24 h. Timely correction of water and electrolyte disturbance, effective antibiotic therapy, high nutrition support, and temporary esophageal, if necessary, are beneficial to the patient’s recovery.