用内窥镜治疗儿童误吞多枚磁铁异物的应用

Endoscopic therapy for accidental ingestion of multiple magnetic foreign bodies in children

目的探讨内窥镜在胃肠道多枚磁铁异物的应用。方法收集2015年1月至2020年1月在福建省妇幼保健院接受诊治的9例误食多枚磁铁异物患儿的临床资料。其中, 男3例, 女6例;年龄范围为1~4岁, 发病时间为2 h至2周;主述症状以无症状为主, 其次为腹痛、呕吐和发热;磁铁异物数量范围为4~25枚。手术治疗方法包括:开腹肠切除吻合、穿孔修补;腹腔镜辅助下经脐部切口提出肠管切开肠管取出异物(肠镜取出剩余异物);腹腔镜探查, 转开腹肠切除吻合并取出异物;开腹肠穿孔修补术;胃镜检查取出部分异物, 腹腔镜下胃穿孔修补, 肠镜取出其余异物;腹腔镜探查, 胃镜下取出异物。结果 6例经内窥镜(腹腔镜、胃十二指肠镜、结肠镜)辅助下取出异物, 2例经传统开腹手术取出异物, 1例经保守治疗后自行排出异物。3例术中发现多处肠管穿孔, 最少2处, 最多5处, 1例发现胃穿孔, 2例术中发现肠内瘘形成。9例患儿随访至今无并发症发生。结论对误食多枚磁铁异物的患儿需采取积极的治疗方案, 内窥镜治疗创伤小、安全有效。

Objective To explore the application of endoscope for ingestion of multiple magnet foreign bodies in gastrointestinal tract.Methods From January 2015 to January 2020,clinical data were reviewed for 9 children with accidental ingestion of multiple magnet foreign bodies.There were 3 boys and 6 girls with an age range of 1 to 4 years and the duration of medical history ranged from 2 hours to 2 weeks;the presenting symptoms were generally asymptomatic,followed by abdominal pain,vomiting and fever;the number of magnet foreign bodies was 4 to 25.Surgical procedures included open intestinal resection&anastomosis,perforation repair;laparoscopic-assisted umbilical incision through umbilical incision,intestinal incision for removing foreign body(speculum for removing the remaining foreign body);laparoscopic exploration,conversion into open intestinal resection and anastomosis(removing foreign body);open intestinal perforation repair;gastroscopy for removing part of foreign body,laparoscopic gastric perforation repair,speculum for removing the remaining foreign body;laparoscopic exploration and gastroscopy for removing foreign body.Results Six cases were removed with the aid of endoscopy(laparoscopy,gastroduodenoscopy&colonoscopy),two cases underwent traditional laparotomy and one case was cured by bowel movement after conservative measures.Multiple intestinal perforation occurred in 3 cases(at least 2 sites and at most 5 sites).There were gastric perforation(n=1)and enteral fistula(n=2).No postoperative complication occurred.Conclusions Aggressive intervention is required for children accidentally ingesting multiple magnet foreign bodies and endoscopic treatment is mini-invasive,safe and effective.