内窥镜治疗上消化道异物病例分析

Case analysis of endoscopic therapy for the foreign bodies in the upper gastrointestinal tract

目的:探讨内窥镜治疗上消化道异物患者中不同异物的取出方法,提高异物取出成功率。方法:收集采用内窥镜治疗的上消化道异物患者2 542例上消化道异物资料,对比分析消化道异物的大小或长短、形状、嵌顿部位和时间以及不同异物类型采用不同器械取出方法的成功率。结果:在2 542例上消化道异物患者中,异物取出率为96.2%(2 446/2 542),其中鱼骨取出率为98.3%(967/984),禽骨取出率为96.5%(356/369),枣核取出率为94.8%(273/280)等。不同部位异物中食管异物取出率为96.8%(2 114/2 185),胃内异物取出率为96.6%(281/291),十二指肠异物取出率为73.5%(25/34),咽部异物取出率为81.0%(17/21),梨状窝异物取出率为77.8%(7/9)。不同器械中异物钳取异物占91.1%(2 317/2 542),圈套器取异物占2.4%(62/2 542),取石网篮取异物占1.3%(34/2 542),内窥镜推入胃内占3.0%(77/2 542)。在2 542例上消化道异物嵌顿患者中,有13例特殊困难异物嵌顿患者均通过黏膜下切开探查,其中6例成功取出,占46.2%(6/13)。结论:内窥镜治疗上消化道异物操作简易、可视性好,对于上消化道异物类型、时机及嵌顿部位选择合适的器械和取出方法,有利于提高异物取出率,降低并发症发生。

Objective:To explore the removal methods of endoscopic therapy for different foreign bodies of patients with foreign bodies in the upper gastrointestinal tract so as to improve the success rate of removing foreign body removal.Methods:The endoscope was adopted to treat patients with foreign bodies in the upper gastrointestinal tract,and the data of 2542 patients with foreign bodies in the upper gastrointestinal tract were selected.The size or length,shape,location and time of embedding of the foreign bodies,as well as the removal methods and success rates of different apparatuses for different type of foreign bodies were compared and analyzed.Results:In 2542 patients with foreign bodies in upper gastrointestinal tract,the removal rate of foreign bodies was 96.2%(2446/2542),of which the removal rate of fish bones was 98.3%(967/984),and that of poultry bones was 96.5%(356/369),and that of date stone was 94.8%(273/280).In the different sites of foreign bodies,the removal rate of foreign bodies in esophagus was 96.8%(2,114/2,185),and that in the stomach was 96.6%(281/291),and that of duodenum was 73.5%(25/34),and that in the pharynx was 81.0%(17/21),and that in the pyriform sinus was 77.8%(7/9).In the different apparatuses of removing foreign bodies,the ratios of the forceps of foreign bodies,the snares device,the reticular basket and the endoscopy that was pushed into stomach were respectively 91.1%(2,317/2,542),2.4%(62/2542),1.3%(34/2542)and 3.0%(77/2,542).A total of 13 patients with special difficult foreign bodies were explored through incision below mucosa,and the foreign bodies of 6 cases were successfully removed in them,which success rate was 46.2%(6/13).Conclusion:Endoscopic treatment of foreign bodies in the upper gastrointestinal tract is simple in operation,which has good visibility.The appropriate choice of apparatus and removal method for the type,the opportune moment and embedding location of the foreign bodies in the upper gastrointestinal tract would contribute to improve the removal rate of foreign body and reduce the occurrence of complication.