食管异物临床特征及穿孔相关危险因素分析

Clinical characteristic of esophageal foreign bodies and risk factors for perforation

[目的]分析食管异物临床特征和食管异物穿孔的危险因素。[方法]回顾性分析食管异物403例临床资料。收集病例的年龄、性别、食管或颈胸部相关疾病,以及异物的特征包括异物嵌顿时间、嵌顿部位、异物种类、异物大小和异物形态是否尖锐等基本信息。按照是否穿孔将病例分为食管异物非穿孔组(A组,369例)和食管异物穿孔组(B组,34例),进行单因素分析及多因素Logistic回归分析。[结果]在年龄上,A组≥65岁占26.3%,B组≥65岁占50.0%,2组在年龄分布比较差异有统计学意义(P<0.05);最常见的异物种类为枣核、骨头、食物团块,B组与A组比较,食管异物为骨头时2组比较差异有统计学意义(P<0.05)。在多因素分析中,嵌顿时间≥8 h(ref:嵌顿时间≤5 h,OR=45.114,95%CI:9.273~814.375,P=0.000)、异物越大(OR=1.758,95%CI:1.180~2.696,P=0.007)和异物嵌顿于食管中段(OR=3.135,95%CI:1.028~8.974,P=0.036)是穿孔的危险因素。[结论]食管异物嵌顿在老年人中较多见,异物为枣核及骨头较多见。食管异物嵌顿超过8 h、异物越大、异物部位位于食管中段可能是引起食管异物穿孔的危险因素。

[Objective]To analyze the clinical characteristics of esophageal foreign bodies and the risk factors for perforation.[Methods]A retrospective analysis of 403cases of esophageal foreign body were divided into group A as non-perforation in esophagus and group B as perforation in esophagus.Patient’s demographic data,including age,gender,cervicothoracic related diseases were collected.Clinical features of the foreign bodies,such as type,size,sharpness of edges,duration of impaction,and location,were analyzed through univariate and multivariate analysis.[Results]The percentage of patients≥65years old in group A accounted for 26%,50%in group B≥65years.There was statistical difference in age distribution between the two groups(P=0.013).The most common foreign bodies in group A and group B were jujube kernels,bone fragments,and food clumps.There was significant difference between group B and group A when the foreign body in esophagus was bone fragments(P=0.026).Multivariate analysis showed that the duration of impaction≥8h(ref:duration of impaction≤5h,OR=45.114,95%CI:9.273-814.375,P=0.000),the larger the foreign body(OR=1.758,95%CI:1.180-2.696,P=0.007)and foreign bodies in the middle of the esophagus(OR=3.135,95%CI:1.028-8.974,P=0.036)were significant independent risk factors associated with esophageal foreign body perforation.[Conclusion]Esophageal foreign body impaction is more common in the elderly.In Ningxia area,jujube nucleus and bone are more common in esophageal foreign body impaction.If the esophageal foreign body is embedded for more than 8hours,the larger the foreign body is,and the location of the foreign body is in the middle of the esophagus,it may be an independent risk factor<6 for the perforation of esophageal foreign body.Sharp bone is also more likely to cause the perforation.