儿童消化道多枚磁性异物31例临床分析

Clinical analysis of 31 children with multiple magnetic foreign bodies in digestive tract

目的探讨儿童消化道多枚磁性异物引起消化道穿孔等严重并发症的危险因素,提高儿科医师及家长对儿童误吞多枚磁性异物危害性的认识。方法收集2013年10月至2019年10月在广州市妇女儿童医疗中心诊治的消化道多枚磁性异物患儿的临床资料,包括性别、年龄、就诊时间、是否有消化道症状、磁性异物种类及数目、并发症表现、干预方式、住院天数及预后,并将其分为有并发症组及无并发症组。采用单因素分析和多因素Logistic回归分析对儿童误吞多枚磁性异物发生并发症的危险因素进行分析。结果共收集误吞多枚磁性异物患儿31例,其中男19例,女12例。年龄1~10岁,其中<3岁9例(29.03%),≥3岁22例(70.97%)。就诊时间平均1 d(95%CI:0.8~3.0 d)。有消化道症状17例(54.84%),磁性异物主要为巴克球磁珠(80.65%)。磁性异物数量2~37枚,中位数6枚(95%CI:5~8枚)。无并发症组18例;有并发症组13例,其中12例表现为消化道穿孔(1例伴胆道梗阻合并局限性胆总管穿孔、梗阻性黄疸及胰腺炎),1例表现胃横结肠瘘。胃镜+外科手术4例,单纯外科手术10例,均取出异物,住院6~15 d;单纯胃镜治疗14例,住院1~2 d,其中胃镜取出异物9例,自行排出5例,排出时间为2~3 d。观察治疗3例,均2~3 d自行排出。31例患儿随访至今均无异常。就诊时间(OR=1.347,95%CI:1.059~1.714)及有无消化道症状(OR=20.990,95%CI:3.593~122.626)是儿童误吞多枚磁性异物发生并发症的危险因素。结论误吞多枚磁性异物的患儿以3岁以上男童多见,误吞后易出现肠穿孔、肠梗阻及肠瘘等并发症。如有消化道症状,需积极行外科手术干预。早期干预可减少并发症的发生。

Objective To explore the risk factors of severe complications such as gastrointestinal perforation caused by multiple magnet ingestion in children,and to improve the recognition of pediatricians and parents on the hazards of children multiple magnet ingestion by accident.Methods Clinical data of multiple magnet ingestion diagnosed in Guangzhou Women and Children′s Medical Center from October 2013 to October 2019 was collected,including gender,age,visit time,accompany gastrointestinal symptoms status,magnet foreign body types and numbers,complications,intervention,hospitalization days and the prognosis.They were divided into 2 groups based on the status of complications(with or without).Risk factors of complications of multiple magnet ingestion in children were analyzed by univariate analysis and multivariate Logistic regression analysis.Results A total of 31 children who mistakenly swallowed magnetic foreign bodies were enrolled,including 19 males and 12 females.The patients aged 1-10 years,including 9 patients<3 years old(29.03%)and 22 patients≥3 years old(70.97%).The average visit time was 1 day(95%CI:0.8-3.0 days).There were 17 cases(54.84%)with gastrointestinal symptoms,and the magnetic foreign bodies were mainly buckyballs(80.65%).The number of magnetic foreign bodies was 2-37,the median number was 6(95%CI:5-8).Except that 18 cases had no complications,13 cases with complications were mainly presented as gastrointestinal perforation(12/13 cases,1 case accompanied by biliary obstruction combined with localized common bile duct perforation,obstructive jaundice and pancreatitis),and 1 case was transverse gastro colonic fistula.Further,4 cases were treated with gastroscopy and surgery,10 cases were treated with surgery alone,foreign bodies were all took out and patient were hospitalized for 6-15 days;14 cases were treated with gastroscopy alone,and were hospitalized for 1-2 days.Among them,foreign bodies in 9 cases were removed by gastroscopy,and 5 cases were expulsed spontaneously after 2-3 days.Three cases accepted observation were expulsed spontaneously after 2-3 days.None of the 31 children was abnormal during the follow-up.The time of visit(OR=1.347,95%CI:1.059-1.714)and the presence of gastrointestinal symptoms(OR=20.990,95%CI:3.593-122.626)were the risk factors for complications of multiple magnetic foreign bodies accidentally swallowed by children.Conclusions Children who swallowed multiple magnetic foreign bodies were more common in boys over 3 years old.Intestinal perforation,intestinal obstruction and intestinal fistula are more likely to occur in children with multiple magnetic foreign bodies swallowed by accident.Surgical intervention is required if gastrointestinal symptoms are occurred.Early intervention may reduce the incidence of complications.