经内镜治疗上消化道异物168例临床分析

Endoscopic management of 168 cases with foreign bodies in the upper gastrointestinal tract

目的探讨内镜治疗上消化道异物的临床效果。方法选取2017年9月至2018年9月于郑州大学第一附属医院行内镜治疗的上消化道异物患者168例,年龄80d^100岁。分析异物类型、异物位置与患者年龄的关系,探讨并发症的影响因素。结果168例上消化道异物中以老年患者多见,占44.1%(74/168),异物位置中食管占78.0%(131/168),异物类型中枣核、果核最多见,为53例。儿童异物主要分布于食管和胃,分别占51.2%、39.0%,青中年的异物也主要分布于食管和胃,分别占77.4%、18.9%,而老年异物主要分布于食管,占93.2%。异物类型不同,好发人群也不同。内镜取出异物成功率为98.2%(165/168),53.6%(90/168)的患者发生相关局部并发症,94.4%(85/90)经内科治疗后痊愈。所有并发症均考虑由异物本身造成,在处理异物过程中未发生相关并发症。并发症的发生率与年龄、异物部位及异物类型有关。老年患者合并相关消化道疾病的比例为33.8%,内镜下取出异物的同时还可完成其他操作。结论内镜是上消化道异物首要的治疗方式,有较好的安全性和有效性,在治疗异物同时,对于发现潜在消化道疾病、治疗原发病或并发症有积极意义。

Objective To analyze the clinical effects of endoscopic treatment of foreign bodies in the upper gastro intestinal tract. Methods A total of 168 patients, aged from 80 days to 100 years, with foreign bodies in the upper gastro- intestinal tract treated by endoscopy in the First Affiliated Hospital of Zhengzhou University from September 2017 to September 2018 were selected. The relationship between foreign body type, foreign body location and patient’s age was analyzed to explore the influencing factors of complications. Results One hundred and sixty-eight cases of foreign bodies in the upper gastro- intestinal tract were more common in elderly patients, accounting for 44.1%(74/168);78.0% foreign bodies (131/168) were in esophagus;and 53 cases of foreign bodies were jujube pits.Foreign bodies in children were mainly distributed in the esophagus and stomach, accounting for 51.2% and 39.0% respectively. The foreign bodies in the middle and young age were mainly distributed in the esophagus and stomach, accounting for 77.4% and 18.9%, respectively. The foreign bodies in the elderly were mainly distributed in the esophagus, accounting for 93.2%. The main types of foreign bodies were different among children, middle and young persons and the elderly. The success rate of endoscopic foreign body removal was 98.2%(165/168), and 53.6%(90/168)of patients had local complications, and 94.4% of them (85/90) recovered after medical treatment. All complications were considered to be caused by the foreign body itself, and no complications occurred during the treatment of the foreign body. The incidence of complications was related to age, foreign body location and foreign body types. The proportion of elderly patients with associated digestive tract diseases was 33.8%, and other operations could be performed while removing foreign bodies under endoscopy. Conclusions Therapeutic endoscopy is the most significant method treating foreign bodies in the upper gastrointestinal tract, which has great safety and effectiveness. Meanwhile, it has great value in discovering invisible diseases and treating primary diseases or complications.