多学科诊疗模式在食管异物规范化诊疗中的应用

Application of multi⁃disciplinary treatment in standardized diagnosis and treatment of esophageal foreign body

目的探讨多学科诊疗模式(MDT)在食管异物诊治中的安全性及有效性,探索需要外科治疗病人的危险因素。方法2014年1月~2021年6月我院心胸外科、消化内科、急诊科、影像科以及麻醉科参与的MDT诊疗的食管异物病人108例。根据治疗方式分为两组,内镜治疗组85例经静脉麻醉内镜取异物;外科手术组23例,行开放手术或开放手术加内镜治疗。比较内镜治疗组与外科治疗组就诊时间、入院时实验室检查结果、异物种类、内镜下表现、嵌顿位置、并发症、术后住院时间等指标的差异。结果内镜治疗组的平均年龄高于外科治疗组[(59.21±13.12)%VS(52.65±12.66)岁,P<0.05],两组就诊时间呈偏态分布,经秩和检验分析表明,外科治疗的病人就诊时间更长,差异有统计学意义(P<0.05)。两组异物类型、食管损伤以及并发症比较,差异有统计学意义(P<0.05)。内镜治疗组和外科治疗组的白细胞计数分别为(7.89±3.08)×10^(9)/L和(11.69±6.98)×10^(9)/L,中性粒细胞计数分别为(6.16±2.96)×10^(9)/L和(9.97±6.97)×10^(9)/L,中性粒细胞占比分别为(76.11±8.75)%和(81.52±12.52)%,C反应蛋白水平分别为(43.26±56.87)mg/L和(111.37±102.86)mg/L,两组比较差异有统计学意义(P<0.05)。结论MDT模式诊治食管异物安全、快速、有效;就诊时间更长、白细胞计数、中性粒细胞计数及中性粒细胞占比更高以及C反应蛋白水平更高的病人需外科手术治疗的可能性较高。

Objective To investigate the safety and efficiency of multiple⁃discipline cooperated diagnosis and treatment on esophageal foreign body and to discover the risk factors of patients who need surgical treatment compared with medical treatment.Methods The information of 108 patients who was diagnosed with esophageal foreign body from January 2014 to June 2021 and accepted multiple⁃discipline cooperated diagnosis and treatment consisted of cardiothoracic surgery department,digestive system department,emergency department,imaging department and anesthesiology department was collected.Then,we compared the difference of clinic time,foreign body type,endoscopic findings,position of incarnation,complications,postoperative hospital stay between surgical treatment and medical treatment.Results Patients in medical treatment were older than surgical treatment[(59.21±13.12)years VS.(52.65±12.66)years,P<0.05].Clinic time shew a skewed distribution,clinic time was longer in surgical treatment compared with medical treatment by rank sum test(P<0.05).There were statistical differences in foreign body type,esophageal injury and complications between the two groups(P<0.05).The white blood cell count of endoscopic treatment group and surgical treatment group was(7.89±3.08)×10^(9)/L and(11.69±6.98)×10^(9)/L,respectively(P<0.05),neutrophil counts were(6.16±2.96)×10^(9)/L and(9.97±6.97)×10^(9)/L,respectively(P<0.05),proportion of neutrophils were(76.11±8.75)%and(81.52±12.52)%,respectively(P<0.05),and C⁃reactive protein level were(43.26±56.87)mg/L and(111.37±102.86)mg/L,respectively(P<0.05).Conclusion Multiple⁃discipline cooperated diagnosis and treatment is safe,rapid and effective in the diagnosis and treatment of esophageal foreign bodies.Patients with longer clinic time,higher white blood cell counts,higher neutrophil counts,higher proportion of neutrophils,and higher C⁃reactive protein level were more likely to require surgical treatment.