内镜下放置金属夹后长期存留在消化道对人体的影响

Impact of long-term retention of metal clips placed in digestive system under endoscope

目的探讨内镜下放置金属夹后长期存留在消化道对人体的影响。方法收集2016年1月-2018年3月该院内镜中心在内镜诊疗中发现消化道有金属夹存留1个月以上的46例患者资料。结果存留时间1个月~5年,平均存留(7.0±0.4)个月。上消化道存留25例,大肠存留21例,共46例,同期使用金属夹的患者共1 498例,占3.1%。上消化道金属夹氧化(锈蚀)8例,占32.0%,大肠存留的金属夹有1枚部分氧化,占4.8%;局部有炎症改变的25例;存留1枚的40例,存留2枚的5例,存留3枚的1例;1例直肠息肉钳除后11个月复查结肠镜发现原部位存留1枚钛夹,并出现1枚新的息肉,病理结果示增生性息肉,局部有明显慢性肉芽肿性炎症改变的13例,占28.3%。上消化道金属夹存留者17例有腹痛症状,占37.0%,大肠金属夹存留患者腹痛1例,占2.2%,腹泻3例,占6.5%。结论金属夹长期存留在消化道有可能导致局部炎症改变及炎性息肉形成,也可引起腹痛、腹泻症状,酸性环境对金属夹有明显氧化(锈蚀)作用,可能诱发毒性反应,应引起内镜及临床医师高度重视。

Objective To study the long-term impact on the human body due to retained metal clips under endoscope.Methods From January 2016 to March 2018,clinical data of 46 patients who had been found to have metal clips placed in the digestive system for more than 1 month under endoscope were collected.Results The retention-time range from 1 month to 5 years,average(7.0±0.4)months.25 cases of upper gastrointestinal,21 cases of large intestine,a total of 46 cases.During period,1498 patients with metal clips,accounted for 3.1%.8 cases of upper gastrointestinal metal clips oxidation,accounted for 32.0%of the upper gastrointestinal metal clips,1 case of large intestinal retention metal clip was partially oxidized(4.8%);local inflammatory changes of 25 patients;40 patients retained one,5 patients retained 2 and 1 patient remained 3;1 case of rectal polyp removed was reexamined after 11 months,which a metal clip and a new polyp was found in the original site,the pathological result showed hyperplastic polyp.There were 13 cases with obvious chronic granulomatous inflammation(28.3%).17 patients with upper gastrointestinal tract metal clips had symptoms of abdominal pain(37.0%).There was one case of abdominal pain in patients with large intestine metal clips(2.2%),and 3 cases of diarrhea(6.5%).Conclusion The long-term retention of metal clips in the digestive tract may lead to local inflammatory changes and inflammatory polyps.It may also cause abdominal pain and diarrhea.Acid environment has obvious oxidation effect on metal clips,which may induce toxic reactions,it should be highly valued by endoscopic and clinic physicians.