儿童消化道磁力珠异物的临床特点及诊治探讨

Clinical characteristics and therapeutic experience of magnetic foreign body ingestion in children

目的探讨儿童消化道磁力珠异物的临床特点及治疗方式。方法回顾性分析2018年9月至2020年5月中国医科大学附属盛京医院收治的13例消化道磁力珠异物患者临床资料,分析其一般资料、临床表现、辅助检查及治疗过程,并复习相关文献,探讨最佳治疗方案。结果13例患者从摄入异物至医院就诊平均时间为4.9 d,临床症状依次为腹痛(7/13,53.8%)、恶心呕吐(6/13,46.2%)、发热(2/13,15.4%)、咳嗽(1/13,7.7%)、血便(1/13,7.7%);2例(2/13,15.4%)无明显临床症状。腹部X线检查显示异物位置:2例(2/13,15.4%)位于上消化道,11例(11/13,84.6%)位于下消化道。13例中,10例予手术治疗,术中发现肠穿孔8例(8/10,80%),其中4例(4/10,40%)伴肠坏死,2例(2/10,20%)瘘管形成伴梗阻,3例(3/10,30%)肠扭转;1例经内窥镜取出异物;2例经保守治疗后自行排出异物。结论误食多枚磁力珠异物可致严重消化道损伤,需要尽早明确诊断并积极治疗。

Objective To explore the clinical features and treatment options of children with magnetic bead foreign body in digestive tract.Methods From September 2018 to May 2020,13 children with magnetic bead foreign body in digestive tract in Shengjing Hospital of China Medical University were recruited.General profiles,clinical symptoms,results of auxiliary examinations and surgical procedures of these patients were retrospectively analyzed to discuss the optimal treatment plan combined with literature researches.Results Among all cases,the average time from ingestion to treatment was 4.9 days.The most common symptoms were abdominal pain(7/13,53.8%),nausea and vomiting(6/13,46.2%),fever(2/13,15.4%),cough(1/13,7.7%),bloody stool(1/13,7.7%),and 2 children(2/13,15.4%)had no obvious clinical symptoms.Abdominal X-ray examinations showed that foreign bodies were located in the upper digestive tract in 2 cases(2/13,15.4%),in the lower digestive tract in other 11 cases(11/13,84.6%).10 of 13 cases were treated by operation,bowel perforation were found in 8(8/10,80%)cases,4 cases(4/10,40%)were accompanied with intestinal necrosis,fistula formation and obstruction were found in 2(2/10,20%)cases,and volvulus were found in 3(3/10,30%)cases.One case was treated by gastroscope,and 2 cases were treated conservatively with magnets and the foreign bodies passed naturally without extra intervention.Conclusion Ingestion of multiple magnetic beads would lead to severe digestive tract injury,which requires early diagnosis and appropriate treatments.