消化道异物的内镜取出109例临床总结

Endoscopic management of foreign bodies in the gastrointestinal tract:A retrospective study of 109 cases

背景摄入的消化道异物是临床中常见的急症.消化道异物个体化内镜取出方法报道较少.目的探讨摄入的消化道异物个体化内镜取出方法,以提高异物内镜取出成功率.方法采用回顾性队列研究,分析2014-07/2019-04在解放军总医院第三医学中心(原武警总医院)消化内镜中心的消化道异物的临床资料及相应的内镜取出的过程特征.结果109例患者纳入研究,其中男46例(42.2%),女63例(57.8%).年龄11岁-88岁,平均年龄57.3岁,其中52例(47.7%)为老年人.最常见的异物是枣核53例(48.6%),其次是鱼骨24例(22%)、食团15例(13.8%).消化道异物最常见的位置是食管84例(76.9%),其次是结肠7例(6.4%),吻合口6例(5.5%),胃和十二指肠分别为5例(4.5%)、5例(4.5%),咽部2例(1.8%).根据异物特点及其滞留部位和患者自身条件,选择合适的取出器械,制定个体化内镜取出方法,其中咽部异物用时间最短,平均时间为2.5±0.7 min.食管上、中、下段异物所用平均时间分别为7.0±5.3 min、8.3±6.3 min、3.3±1.2 min.吻合口处异物所用时间6.2±4.1 min.胃内异物和十二指肠异物所用平均时间为8.4±1.7 min和9.2±3.1 min.结肠异物所用时间最长,平均时间为15.6±8.0 min.消化道异物内镜取出成功率为97.2%(106/109).结论根据异物特点及其滞留部位和患者自身条件个体化内镜取出消化道异物是安全、有效的方法.

BACKGROUND The ingestion of foreign bodies in the gastrointestinal tract is commonly encountered in clinical practice.Reports on individualized endoscopic removal of gastrointestinal foreign bodies are scarce.AIM To explore the method of individualized endoscopic removal of indigested foreign bodies in the gastrointestinal tract to improve the success rate of foreign body endoscopic removal.METHODS The clinical data of patients with digestive tract foreign bodies treated at the Third Medical Center of PLA General Hospital(former General Hospital of Armed Police Forces)from July 2014 to April 2019 were retrospectively analyzed.RESULTS One hundred and nine patients were included in the study,including 46 men(42.2%)and 63 women(57.8%).Their age ranged from 11 to 88 years,with an average age of 57.3 years;52 cases(47.7%)were elderly.The most common type of foreign body was jujube kernel(53 cases,48.6%),followed by fish bone(24 cases,22%)and food mass(15 cases,13.8%).The most common location of foreign bodies in the digestive tract was the esophagus(84 cases,76.9%),followed by the colon(7 cases,6.4%),anastomosis(6 cases,5.5%),stomach(5 cases,4.5%),and duodenum(2 cases,1.8%).Pharynx foreign bodies can be directly removed with foreign body forceps,with the shortest time taken(average,2.5±0.7 min).For esophageal foreign bodies,foreign body forceps were used to clamp one end of the foreign bodys,exert to the opposite side,make it leave the mucous membrane and parallel to the lumen,and then remove.The foreign body in the upper part of the esophagus can be added with a casing or transparent cap.The foreign body in the lower esophagus can be pushed into the stomach and then removed under the endoscope.The average time taken for removal of foreign bodies in the upper,middle,and lower esophagus was 7.0±5.3,8.3±6.3,and 3.3±1.2,respectively.Anastomosis foreign bodies were often removed using a trap,and the average time taken was 6.2±4.1 min.When removing the foreign body in the stomach,appropriate instrument should be selected according to the shape of the foreign body.In order to avoid scratching the mucosa by the tip of the foreign body,a transparent cap or a self-made protective device can be used.The average time used was 8.4±1.7 min.Duodenal foreign body was usually dragged into the stomach tbefore removal,and the average time taken was 9.2±3.1 min.Colonic foreign bodies mainly occurred in the sigmoid colon and were very difficult to remove.A clamp was usually used to clamp one end of the foreign body,exert to the opposite side,cause it to be parallel to the intestinal lumen,and then remove.The longest time was taken for colonic foreign bodies,with an average time of 15.6±8.0 min.The success rate of endoscopic removal of foreign bodies in the digestive tract was 97.2%(106/109).CONCLUSION Individualized endoscopic removal of gastrointestinal foreign bodies is a safe and effective method.