儿童上消化道异物致穿孔32例临床分析

Clinical analysis of 32 children with perforation caused by foreign body in upper gastrointestinal tract

目的探讨儿童误吞异物致上消化道穿孔的临床特点及诊治方法。方法回顾性分析2011年1月至2019年2月河南省儿童医院收治的误吞异物致上消化道穿孔患儿32例。采集患儿年龄、性别、异物类型、穿孔部位、误吞时间、临床症状、治疗方法及预后。结果32例患儿中,男20例(62.5%),女12例(37.5%);好发年龄0~<3岁(21/32例,65.6%)。引起穿孔最常见异物为枣核[13例(40.6%)],其次为纽扣电池10例(31.2%),磁铁3例(9.4%),鱼刺2例(6.3%),棒棒糖柄2例(6.3%),纽扣电池及磁铁混合异物1例(3.1%),金属针1例(3.1%)。食管为最常见穿孔部位(25/32例,78.0%),尤以食管上段多见(15/25例,60.0%)。常见症状有发热22例(68.8%),吞咽困难和/或流涎21例(65.6%),呕吐24例(75.0%),腹痛5例(15.6%),呼吸困难1例(3.1%)。患儿均经内镜或手术顺利取出异物,内镜取出28例(87.5%),手术取出4例(12.5%);旷置穿孔部位、肠内营养后痊愈24例(75.0%),钛夹夹闭穿孔部位后痊愈2例(6.3%),手术修补上消化道穿孔6例(18.7%)。结论上消化道异物是儿科常见急症,尖锐异物枣核、腐蚀性异物纽扣电池及磁性异物是导致消化道穿孔的主要原因。上消化道异物经电子胃镜取出成功率高,但经内镜取物失败需及早外科干预。

Objective To explore the clinical characteristics and treatment strategies of upper gastrointestinal perforation caused by ingested foreign bodies in children.Methods A retrospective analysis of 32 patients with upper gastrointestinal perforation secondary to foreign bodies in Henan Children′s Hospital from January 2011 to February 2019 was performed.Some basic information was collected,including age,gender,type of foreign bodies,location of perforation,time of swallowing,clinical symptoms,treatment methods and outcomes.Results Among the 32 children,there were 20 cases(62.5%)were male and 12 cases(37.5%)were female.The predilection age was 0 to<3 years old[21 cases(65.6%)].The most common type of upper gastrointestinal foreign bodies was jujube pits[13 cases(40.6%)],followed by button batteries[10 cases(31.2%)],magnets[3 cases(9.4%)],fish bones[2 cases(6.3%)],lollipop stick[2 cases(6.3%)],button battery combined with magnet[1 case(3.1%)]and metal pin[1 case(3.1%)].Majority of perforation was located in the esophagus[25 cases(78.2%)],especially in the upper esophagus[15/25 cases,(60.0%)].The common symptoms of upper gastrointestinal perforation include fever[22 cases(68.8%)],dysphagia and/or salivation[21 cases(65.6%)],vomiting[24 cases(75%)],abdominal pain[5 cases(15.6%)]and expiratory dyspnea[1 case(3.1%)].All the foreign bodies were successfully extracted by endoscopy[28 cases(87.5%)]and surgery[4 cases(12.5%)].Moreover,all the patients recovered with both treatments of indwelling gastrointestinal decompression tube and enteral nutrition,including nasojejunal tube[24 cases(75.0%)],endoscopic hemoclip and nasojejunal nutrition[2 cases(6.3%)],and surgical operation[6 cases(18.7%)].Conclusions The upper gastrointestinal foreign body is a common emergency in children,and might cause perforation,especially jujube pits,button batteries and magnets.The endoscopic procedure is safe and effective for the removal of foreign bodies.However,the surgical intervention is required as soon as possible due to the failure of endoscopic treatment.