纽扣电池导致食管异物病儿11例临床治疗分析

CLINICAL TREATMENT OF ESOPHAGEAL FOREIGN BODIES CAUSED BY BUTTON BATTERIES:AN ANALYSIS OF 11 CASES

目的总结纽扣电池导致食管异物病儿的临床治疗经验。方法回顾性分析我科收治的11例纽扣电池导致食管异物病儿的临床资料,并进行文献复习,总结相关的临床治疗经验。结果10例病儿经全身麻醉下硬管食管镜取出异物,1例病儿经全身麻醉下颈侧入路切开食管取出异物。术后6例病儿经胃肠减压及鼻饲饮食适当天数后拔管;1例病儿空肠营养管营养治疗21 d后行上消化道X线造影检查,未见对比剂外漏征象;1例病儿胃肠减压2 d后行鼻饲流质饮食70 d拔管;其余3例病儿给予流质饮食2 d后嘱半流质饮食2周。出院后电话随访至今,11例病儿均未再出现严重并发症。结论儿童将纽扣电池误吞入食管后会灼伤和腐蚀食管及周围脏器,应尽早行手术取出电池异物;术后可根据食管黏膜损伤情况决定是否给予鼻饲流质饮食,必要时可行消化道碘油造影观察病儿有无消化道穿孔。

Objective To summarize the experience in the clinical treatment of children with esophageal foreign bodies caused by button batteries.Methods A retrospectively analysis was performed for the clinical data of 11 children with esophageal foreign bodies caused by button batteries in our department,and a literature review was performed to summarize related experience in clinical treatment.Results Hard-tube esophagoscopy was performed for 10 children under general anesthesia to remove the foreign body,and the esophagus was cut open via the lateral cervical approach under general anesthesia to remove the foreign body.After surgery,6 children achieved extubation after gastrointestinal decompression and nasogastric feeding for an appropriate number of days;1 child underwent upper gastrointestinal tract X-ray after nutrition treatment with a jejunum nutrition tube for 21 d,which showed no sign of contrast agent leakage;1 child achieved extubation after gastrointestinal decompression for 2 days followed by nasogastric feeding of liquid diet for 70 d;3 children were given the advice of semi-liquid diet for 2 weeks after liquid diet for 2 d.The children were followed up via telephone after discharge,and up to now,no serious complication was observed.Conclusion After children swallow a button battery through the esophagus,the battery will burn and corrode the esophagus and surrounding organs.Therefore,surgery should be performed to remove the battery foreign body as soon as possible.Whether nasogastric feeding of liquid diet is required should be determined based on esophageal mucosa injury after surgery,and lipiodol radiography of the digestive tract can be performed when necessary to observe the presence or absence of digestive tract perforation.