上消化道异物267例内镜诊治分析

Endoscopic management of foreign bodies in the upper gastrointestinal tract: the retrospective study of 267 cases

目的分析上消化道异物的种类、异物所在上消化道解剖位置及胃镜治疗效果。方法对广州市第一人民医院2000年1月至2017年2月做胃镜检查患者的结果进行统计,对其中疑诊上消化道异物者的胃镜结果进行分析,并对所发现异物给予相应内镜治疗,分析上消化道异物种类、所在解剖位置分布情况。结果共267例患者疑诊为上消化道异物,262例确诊为上消化道异物,5例未发现异物,仅见食管上段黏膜损伤。262例异物患者有259例胃镜下成功取出,3例胃镜无法取出。从异物嵌顿到就诊时间2 h^8 d。所有异物在嵌顿24 h内就诊且胃镜取出者无严重并发症发生,而超过24 h才就诊者,均伴发较严重并发症,包括食管-气管瘘,需住院治疗,甚至行外科手术处理。对262例异物嵌顿解剖位置进行分析,食管异物最多,达166例(63.36%),胃内异物共63例(24.05%),十二指肠及胆道、胰管异物共27例(10.31%),吻合口4例(1.53%),咽部异物2例(0.76%)。异物种类以食源性异物多见,达151例,其中以动物骨性异物最常见,达110例;非食源性异物111例,种类较繁多,包括金属片28例,各种支架14例,牙签12例,打火机11例,胃石8例,药物及锡箔外包装7例,硬币5例,义齿5例,塑料片及陶瓷类5例,牙刷3例,其他包括胶囊内镜、玻璃瓶、筷子、纽扣等共13例。结论上消化道异物以食管最多见,以食源性异物最多见,其他异物种类较多。内镜下取出是安全有效的,对于上消化道异物,应尽早内镜下处理,延缓处理会导致严重并发症。

Objective To investigate the types and anatomical location of foreign bodies in the upper gastrointestinal tract and the value of endoscopic treatment. Methods From Jan. 2000 to Feb. 2017,all consecutive patients with suspected foreign body ingestion were enrolled in Guangzhou First People＇s Hospital. The endoscopic management,the species and the anatomical distribution of foreign body were analyzed. Results A total of 267 patients with suspected foreign body ingestion underwent endoscopic management. Among them,262 cases were identified with foreign body,no foreign bodies were found for 5 cases. Two hundred and fifty nine cases（ 98. 85%） of foreign body were successfully removed with flexible endoscopy,3 cases failed. The duration of foreign body impaction ranged from 2 hours to 8 days,and for the duration of impaction within 24 hours,no serious complications occurred,while for duration longer than 24 hours,the complication rate increased obviously,including esophageal-tracheal fistula and needed further treatment,including surgery. For the anatomical location of foreign body,there were 166 cases of the esophagus（ 63. 36%）,63 cases of the stomach（ 24. 05%）,followed by the duodenum,bile duct and pancreatic duct（ 27 cases,10. 31%）,and 4 cases of surgical anastomosis（ 1. 53%）,2 cases of the pharynx（ 0. 76%）. Food related foreign bodies were seen in151 cases,including 110 cases of bony foreign bodies,30 cases of food bolus impaction,another 11 cases were carpodermis and hardcore. One hundred and eleven cases of non-food related foreign body were as follows： 28 cases of metal related foreign body,stents（ 14 cases）,toothpicks（ 12 cases）,lighters（ 11 cases）,gastric calculi（ 8 cases）,Tin foil drug package（ 7 cases）,coins（ 5 cases）,dentures（ 5 cases）,plastics and ceramics（ 5 cases）,toothbrush（ 3 cases）,another 13 cases including capsules,glass bottle,chopsticks and button,and so on. Conclusion Most foreign bodies located in the esophagus,and food related foreign body are more common,the categories of non-food related foreign body were various. For upper gastrointestinal tract foreign body,endoscopic management is safe and effective,and should be handled as soon as possible,delay treatment will lead to serious complications.