儿童上消化道异物的临床特点及胃镜诊治效果

Clinical Characteristics of Foreign Bodies in Children Upper Digestive Tracts and the Effect of Gastroscopy on Diagnosis and Treatment

目的:分析儿童上消化道异物临床特点、无痛胃镜及普通胃镜对儿童上消化道异物的诊治效果。方法:分析60例上消化道异物患儿的发病年龄、常见异物种类及常见部位,根据是否给予麻醉分为无痛胃镜组(n=30)与普通胃镜组(n=30),比较两组患儿术中生命征、不良反应发生率、异物钳取成功率及钳取时间。结果:60例患儿发病年龄8个月~6岁、平均(1.05±0.8)岁,其中0~3岁42例、占比70%;常见异物最多为硬币(占比68%,41/60)、其次为纽扣电池(占比11%,7/60)及玩具残片(占比8.3%,5/60),异物常见部位最多为胃腔(占比38.3%,23/60)、其次为食道(占比26.7%,16/60)及胃窦(占比21.7%,13/60);无痛胃镜组患儿夹取异物术中呼吸、心率及血氧饱和度(SpO2)均显著低于普通胃镜组(P<0.05),异物取出成功率及在<5min内取出异物的比例显著高于普通胃镜(P<0.05);无痛胃镜组术中恶心/呕吐、躁动、出血及呛咳反应发生率显著低于普通胃镜组(P<0.05)。结论:儿童上消化道异物发病率以婴幼儿最高,以硬币、纽扣电池最常见,部位多为胃腔及食道,无痛胃镜治疗儿童上消化道异物安全性和有效性优于普通胃镜。

Objective: To analyze the clinical characteristics of foreign bodies in children upper digestive tract (FBUDT) and the effects of painless gastroscopy and ordinary gastroscopy on the diagnosis and treatment of children FBUDT. Methods: Sixty children with FBUDT were enrolled.We analyzed the age of onset,common types of foreign bodies and common sites where foreign bodies were found.According to whether or not anesthesia was given,it was divided into painless gastroscopy group (anesthesia, n =30) and ordinary gastroscope group (no anesthesia, n =30).Intraoperative vital signs,incidence of adverse reactions,foreign body clamp success rate and clamping time were compared. Results: The age of onset of 60 children ranged from 8 months to 6 years old,with an average of (1.05±0.8) years.Among them,the ages of 42 children were from 0 to 3 years old,accounting for 70%.The most common type of foreign bodies was a variety of coins (68%,41/60),followed by button batteries (11%,7/60) and toy fragments (8.3%,5/60).The most common location of foreign bodies is gastric cavity (38.3%,23/60),followed by the esophagus (26.7%,16/60) and gastric antrum (21.7%,13/60). The extent of the pain,heart rate and SpO 2 were significantly lower in the painless gastroscopy group than those in common gastroscopy group ( P <0.05).The success rate of foreign body removal and the proportion of foreign bodies taken out within <5 min were significantly higher in the painless gastroscopy group than those in ordinary gastroscopy group ( P <0.05).The incidence of nausea/vomiting,agitation,hemorrhage and cough response were remarkably lower in the painless gastroscopy group than those in ordinary gastroscopy group( P <0.05). Conclusion: The incidence rate of FBUDT is the highest among infants and young children.Coins and button batteries are the most common type of foreign bodies.The most common sites where foreign bodies were found are gastric cavity and esophagus.The safety and effectiveness of painless gastroscopy on treating children FBUDT is better than those of ordinary gastroscopy.