儿童误吞磁性异物引起消化道穿孔30例临床分析

Clinical analysis of 30 cases of digestive tract perforation caused by ingestion of magnetic foreign bodies in children

目的分析及总结儿童误吞磁性异物引起消化道穿孔的临床特点及手术方式。方法收集西安市儿童医院自2012年12月至2020年12月共收治的30例因误吞磁性异物引起消化道穿孔的患儿基本信息,根据发病时间长短分组,比较两组的住院天数及肠穿孔数量;根据误吞磁力珠数量多少分组,比较两组的肠穿孔数量。结果术中发现磁性异物位于胃、十二指肠、空肠及回肠、结肠;胃肠道穿孔27例,形成内瘘3例;16例行异物取出穿孔修补术,14例行肠切除肠吻合术;术后随访半年以上,3例出现粘连性肠梗阻,经保守治疗治愈;发病时间较短的患儿住院天数、胃肠道穿孔数量均小于发病时间较长的患儿,差异均有统计学意义(t值分别为3.15、2.34,P<0.05);误吞磁力珠较少的患儿胃肠道穿孔数量小于误吞磁力珠较多的患儿,差异有统计学意义(t=2.83,P<0.05)。结论误食磁性异物对儿童危害性较大。就诊越早消化道穿孔数量越少,住院时间也越短。发病时间短、穿孔数量少可行穿孔修补术;发病时间长、穿孔部位多需行肠切除肠吻合术。

Objective To analyze and summarize clinical features and surgical procedures of gastrointestinal perforation caused by ingestion of magnetic foreign bodies in children.Methods The basic data of 30 children with gastrointestinal perforation caused by ingested magnetic foreign bodies in Xi′an Municipal Children′s Hospital from December 2012 to December 2020 were collected.The patients were divided into long course group(≥6 days) and short course group(<6 days) according to length of course of the disease, and hospitalization days and number of intestinal perforation of the patients were compared between the two groups.On the other hand, the patients were divided into less magnetic beads ingested group(<10 beads) and more magnetic beads ingested group(≥10 beads) according to number of magnetic beads ingested, and number of intestinal perforation of the patients were compared between the two groups.Results Magnetic foreign bodies were found in operation in patients′ stomach, duodenum, jejunum, ileum and colon.Gastrointestinal perforation occurred in 27 patients, and internal fistula occurred in 3 patients.16 patients underwent foreign body removal and gastrointestinal perforation repair operation, and 14 patients underwent resection of the perforated bowel and anastomosis.The patients were followed up for more than half a year after operation, and 3 patients developed adhesion ileus, and luckily they cured by conservative treatment.The length of hospital stay and the number of gastrointestinal perforation of the patients with short course of the disease were shorter and less than those patients with long course of the disease, and the differences were statistically significant(t=3.15 and 2.34 respectively, both P<0.05).The number of gastrointestinal perforation of the children with less magnetic beads ingested was less than that of those children with more magnetic beads ingested(t=2.83,P<0.05).Conclusion Magnetic foreign bodies are harmful to children.The earlier the treatment, the less the number of gastrointestinal perforation and the shorter the length of hospital stay.The perforation repair can be performed on those children with shorter course and less number of perforation, and enterectomy and anastomosis are necessary for those children with long course and more perforation site.