食管异物诊治:手术或者内镜?

Diagnosis and treatment of esophageal foreign body: Operation or endoscopy?

目的总结食管异物治疗经验,为食管异物的诊治提供借鉴。方法回顾性分析空军军医大学附属第二医院2011年12月—2019年5月共149例食管异物患者的临床资料,其中女75例(50.3%)、男74例(49.7%),平均年龄57(2~85)岁。结果146例经胃镜确诊,3例未发现异物。127例经胃镜取出,19例经手术治疗。食管异物以食源性为主,西北地区常见异物为枣核。48 h内取出异物黏膜损伤发生率为47.54%,48 h后取出异物者并发症发生率为100.0%。异物合并穿孔取出成功率低(P=0.005),超细胃镜在难取的颈部异物和其它部位异物差异无统计学意义(P=0.157)。结论异物越尖锐,越易穿孔;异物越早取出并发症越少;异物的大小决定内镜下取出的难易程度;确诊及治疗首选软式内镜,尤其是超细胃镜,内镜无法取出的异物再行手术治疗。

Objective To summarize our experience in the treatment of esophageal foreign bodies.Methods A retrospective analysis of 149 patients of esophageal foreign bodies in the Second Affiliated Hospital of Air Force Military Medical University from December 2011 to May 2019 was carried out,including 75(50.3%)females and 74(49.7%)males with an average age of 57(2-85)years.Results There were 146 patients confirmed by endoscopy,and 3 patients were not found foreign body.Among the confirmed patients,127 patients were removed by gastroscope and 19 patients were treated by operation.Esophageal foreign bodies are mainly related to the types of food.Jujube seed is the most common food foreign body in the northwest China.The injury rate of mucosal was 47.54%within 48 hours.The complication rate of taking out the foreign body after 48 hours was 100.0%.The success rate by endoscopy decreased(P=0.005),if the foreign body combined perforation.There was no statistical difference between the neck and other parts when using ultrafine gastroscope(P=0.157).Conclusion The sharper the foreign body is,the easier the perforation is.The earlier the foreign body is removed,the less complications are.The size of the foreign body determines the difficulty of endoscopic removal.Gastroscopy is the first choice for diagnosis and treatment,especially ultra-fine gastroscopy,and the foreign bodies that cannot be removed by endoscopy need surgical treatment.