儿童误食磁性异物致消化道损伤的临床经验总结

Clinical experience summary of gastroinstinal injury caused by magnets ingestion in children

目的探讨儿童误食磁性异物致消化道损伤的临床特点、致病机制及诊治方法,为临床决策提供理论依据。方法回顾性分析2017年10月—2021年9月安徽省儿童医院收治的46例消化道磁性异物患儿的临床资料,根据是否存在消化道穿孔将患儿分为消化道穿孔组(n=28)和消化道未穿孔组(n=18)。观察患儿性别、年龄、吞食异物时间、异物数量、临床症状、外周血白细胞计数、中性粒细胞计数、血清C反应蛋白水平、治疗方法、胃肠道损伤情况、随访情况等。两组先进行单因素分析,对差异有统计学意义的变量再纳入Logistic回归模型进行多因素分析。偏态分布的计量资料以M(Q1,Q3)表示,两组间比较采用Wilcoxon Mann-Whitney检验;计数资料组间比较采用χ2检验或校正χ2检验。结果全组46例患儿中,男性33例,女性13例;年龄8个月至11岁,中位年龄3岁;就诊时明确异物吞食史34例,不明确吞食异物者12例。吞食异物数量2~10枚最多见,为25例。常见症状有呕吐18例和腹痛13例。6例最终自行排出异物,5例经胃镜取出异物,35例进行了腹腔探查手术后取出。28例存在消化道穿孔,最常见穿孔位置是回肠,为18例。单因素分析发现,消化道穿孔组与消化道未穿孔组患儿是否存在症状、外周血白细胞计数、外周血中性粒细胞计数、血清CRP水平差异具有统计学意义(P<0.05)。多因素Logistic回归分析发现,就诊时存在症状(OR=4.715,95%CI:1.074~20.696,P=0.040)、CRP升高(OR=11.605,95%CI:1.132~118.981,P=0.039)是存在消化道穿孔的独立危险因素。相关性分析发现磁性异物数量与消化道穿孔数量之间没有显著的相关性(r=0.276,P>0.05)。结论误食磁性异物可能会引起消化道穿孔等严重并发症,明确诊断后应积极进行干预,吞食时间较短者可尝试经胃镜取出,内镜治疗失败者应尽早外科手术。

Objective To explore the clinical characteristic,pathogenesis,diagnosis and treatment strategies of gastroinstinal injury caused by magnets ingestion in children.Methods A retrospective analysis of 46 patients with gastrointestinal tract magnets ingestion in Anhui Provincial Children′s Hospital from October 2017 to September 2021 was performed.Patients were divided into different groups according to gastroinstinal perforation.Some basic information was collected,including gender,age,duration of swallow foreign bodies,quantity of foreign bodies,symptoms,white blood cell,neutrophil,C-reactive protein,therapeutic method,gastroinstinal injury and follow up.Logistic regression.Univariate analysis and multivariate Logistic regression were used to analysis the risk factors of gastroinstinal perforation.Continuous parametric data were summarized using median and interquartile range,differences were evaluated using Wilcoxon Mann-Whitney test.Noncontinuous data were analyzed using chi-square test or corrected chi-square test.Results Among the 46 patients,there were 33 males and 13 females.The median age was 3 years,with a range of 8 months to 11years.34 cases had a history of ingesting magnets.The common number of ingested magnets was 2-10(25 cases).Vomiting(18 cases)and abdominal pain(13 cases)were the commonest complaint.6 cases tend to pass through the gastrointestinal tract uneventfully,and the remaining cases were successfully extracted by endoscopy(5 cases)and surgery(35 cases).Gastroinstinal perforation was found in 28 cases,and the majority of perforation was located in the ileum(18 cases).Univariate analysis showed that symptom,white blood cell,neutrophil,and CRP were associated with gastroinstinal perforation(P<0.05).Multivariate Logistic regression analysis showed that symptom(OR=4.715,95%CI:1.074-20.696,P=0.040)and CRP(OR=11.605,95%CI:1.132-118.981,P=0.039)were independent factors for gastroinstinal perforation.There was no significant correlation between the number of magnets and gastroinstinal perforation(r=0.276,P>0.05).Conclusions The ingestion of magnetic foreign bodies in children often requires urgent management.When magnets are located within the prepyloric part of the GI tract,retrieval by endoscopy is recommended.The surgical intervention is required as soon as possible due to the failure of endoscopic treatment.