农村食管异物住院患者的护理——附128例病例报告

目的 探讨农村食管异物住院患者的护理。方法 对128例住院的食管异物患者进行临床统计分析。结果 本组患者除1例石块食管异物经颈侧切开取出者外，其余均经食管镜取出，痊愈出院。结论 128例住院食管异物患者，经过精心的护理和积极的支持疗法，在常规检查后，及时地上食管镜取出和颈侧切开取出异物，所有患者均迅速康复，无并发症发生，治愈率在100％。     

食管异物的早期外科处理

食管异物在日常生活中极为常见，绝大多数患者可经食管镜或纤维胃镜取出异物；然而部分患者不能取出或强行取出后，有可能导致食管穿孔、主动脉损伤甚至死亡。本科自1987年5月至2005年5月对12例经食管镜及胃镜处理后，不能取出及取出异物后出现并发症的食管异物患者需外科处理的诊治体会报道如下。     

四川大学华西医院胸外科与消化内科、麻醉科建立复杂食管异物联合治疗快速路径

2014年2月9日，四川大学华西医院胸外科联合消化内科成功为1例食管异物患者实施了异物取出手术。该患者为老年男性，5天前不慎误乔假牙，假牙嵌顿于上段食管，周围食管组织肿胀明显，异物取出难度大，风险高。     

自杀患者食管异物食管镜手术探讨

目的：探讨硬质食管镜技术在自杀型食管异物手术中的应用。方法：运用硬质食管镜对11例自杀型患者吞入的复杂性食管异物进行取除。结果：11例患者均成功聚除异物。未发生并发症。结论：硬质食管镜技术适用于复杂，危险性大的食管异物的取除。必要的手术方案是成功关键。     

高危食管异物的急诊手术治疗

食管异物大多数可经内窥镜取出。但一些形状不规则、带钩、锐利边缘、嵌顿于大血管旁、停留时间较长的食管异物有很大的危害，极易造成穿孔、严重感染和大出血死亡。我院从1992年2月-2001年12月，共收治食管异物患者43例，其中高危食管异物13例，行急诊外科手术取得了满意疗效。现报告如下。     

多排螺旋 CT 诊断食管枣核异物的应用价值

目的：探讨多层螺旋 CT(MSCT)诊断食管枣核异物的应用价值。方法回顾我院16例食管枣核异物行食管钡餐造影检查、MSCT 扫描的患者资料,分析食管枣核异物食管钡餐造影检查及 MSCT 表现,并与内镜结果对照。结果16例食管枣核异物患者中,MSCT 检出异物16例(100%),食管周围并发症6例;食管钡餐造影检出异物6例(37.5%),并发症未检出。MSCT 对异物及并发症的检出率明显高于钡餐造影。结论 MSCT 及其重建技术如能准确显示食管异物及其周围并发症,可以作为食管枣核异物的首选检查方法。     

螺旋CT对食管骨性异物的诊断及临床应用价值

目的探讨螺旋CT对食管骨性异物的诊断价值。方法收集2009年7月-2011年12月临床有明确异物摄入史患者36例,采用螺旋CT检查,观察异物的位置、大小、形状、走行及食管周围损伤情况,并通过食管镜或手术进一步证实。结果 36例患者中,26例食管骨性异物均被CT检出,包括鸡骨15例、鸭骨5例、鱼骨及鱼刺6例,检出率100%,与食管镜或手术结果比较,准确性及灵敏度均为100%。10例患者螺旋CT未发现确切异物。23例异物位于食管颈段,3例位于食管胸段。异物形状多为条状,还有小片状或不规则状,异物在食管内走向可呈横位,斜形和纵形。异物并发食管壁充血水肿8例,损伤性食管炎5例,咽后脓肿2例。结论螺旋CT可准确、全面的显示食管骨性异物及其并发症情况,可作为食管异物患者首选的理想检查方法。     

食管镜检查导致纵隔及颈部巨大窦道1例

患者女，64岁，农民。6年前因进食后不适，作钡餐检查发现食管异物，经食管镜取出，余来见异常。9天前，患者进食瘦肉后，感吞咽困难，在当地诈钡餐检查，发现食管异物，后经多次食管镜检查，均未取出异物，患者于1997年9月8日以食管异物转入我院。查体：一般情况尚可，体温37．6℃。颈部右侧稍隆起，有压痛，WBC：80X109／L，N79％。正位胸片显示右侧少量气胸。食管吞钡检查：钡刘顺刮通过食管中上段，在食管下段受阻，并可见该处有一不规则充盈缺损，多次吞钡其位置无移动。食管各段蠕动正常，管壁光整。在食管颈段有一开口，钡刘经此…     

纤维食管镜直视下取异物的体会

我院自1985年～1997年应用XS－4型纤维食管镜直视下对8例食管异物患者进行食管检查和异物错取，均获成功，成功率达100％，现报告如下。1临床资料食管内异物8例，均为男性；年龄最大71岁，最小22岁。2例为异物误入，6例为食管癌术后吻合口狭窄进食发生阻塞。异物种类：肉块4例，面团3例，鱼骨1例，西瓜籽1例。2方法术前详细询问病史，胸部透视、拍片，做心电图。禁食禁水，润滑止痛胶0．5～1g滴于舌根部。3体会3．1经食管取异物要具体情况具体分析处理，掌握错取的适当时机，减轻操作难度，同时钳取异物时要有信心和耐心。关于食管镜的型号…     

河南省长垣地区食管异物90例临床分析

食管异物屡见不鲜,大部分异物可以顺利通过食管、胃肠道,经肛门排出,对人体不造成损害[1],但仍有部分不能顺利通过,而嵌顿在消化道的不同部位,特别是食管。近年来,食管异物已逐渐成为河南宏力医院消化内镜中心的常见的急症之一。本文回顾性研究前来我院就诊的食管异物患者90例,观察患者年龄、异物部位、异物种类及异物停留时间,分析本地区食管异     

58例食管中段异物的诊断和处理评价

目的：评价食管中段异物的诊断及内镜下治疗措施。方法：在内镜直视下根据不同类型的异物应用不同的器械将异物取出。结果：58例食管中段异物，内镜下取出53例，成功率91．40％，除1例发生纵隔气肿外，均无其它并发症发生。未能取出异物的5例，均系病程超过48h，有穿孔并发症迹象，其中鱼刺4例，义齿1例。经外科治疗后死亡2例。结论：内镜下食管中段异物取出术是一种安全、有效的治疗方法。     

Endoscopic removal of sharp foreign bodies impacted in the esophagus.

BACKGROUND AND STUDY AIMS: Impacted sharp foreign bodies in the esophagus can be very difficult to manage. When attempts are made to remove such objects inappropriately, life-threatening complications such as perforation can occur. The aim of this study was to evaluate the safety and efficacy of endoscopic removal of impacted sharp foreign bodies in the esophagus using proximal dilatation with an oral side balloon or transparent cap. PATIENTS AND METHODS: A total of 22 patients (10 men, 12 women) with impacted sharp foreign bodies in the esophagus underwent endoscopic extraction. The following technique was successfully performed at our hospital. An oral side balloon (Top Co., Japan) for esophageal variceal sclerotherapy was attached to the distal part of the endoscope. With the patient under local anesthesia, the endoscope was inserted as far as the proximal part of the esophageal foreign body. The oral side balloon was then gradually inflated. Dilatation of the proximal part of the esophagus made it possible to release the impacted sharp foreign body from the esophageal wall. A transparent cap was used for foreign bodies in the upper esophagus when there were difficulties with the oral side balloon. RESULTS: The types of foreign body removed were fish bones (n = 9), press-through packages (n = 8), chicken bones (n =3), dentures (n = 1), and a wrist watch (n = 1). Endoscopic removal was successful in all but one of the cases, in which a fish bone had to be extracted surgically. CONCLUSIONS: The proximal dilatation method using an oral side balloon or transparent cap is safe and effective in removing sharp foreign bodies from the esophagus, avoiding surgery and possible perforation.     

急诊内镜取除食管异物48例临床分析

目的探讨急诊内镜治疗食管异物的可行性和如何提高成功率。方法对我院48例急诊内镜取食管异物的资料作一回顾性分析。结果45例异物成功取出,2例钳碎后进入胃内,1例失败,转上级医院诊治,总成功率为97．9％。结论急诊内镜取食管异物安全可靠,成功率高,应作为食管异物的首选治疗方法。     

食管异物252例临床分析

摘要：目的??探讨食管异物的临床特点及相应的治疗方法。方法?收集2010年6月－2018年6月该院收治的252例食管异物患者的临床资料。其中,男114例,女138例,年龄1～87岁,中位年龄52岁。所有患者均有明确的误吞或自食异物病史,并伴有吞咽困难及吞咽疼痛等症状,均行胸部X线、CT或食管钡剂检查以确诊。结果?成人异物种类以植物性最多见,枣核为67.06%;其次为动物性,骨头为15.87%。小儿异物绝大部分为硬币,占8.33%。异物停留部位最多为食管上段（93.25%）,其次为食管中段,占4.76%,食管下段极其少见。行硬性食管镜取出异物者占绝大多数（92.85%）,所有患者中出现严重并发症者13例。结论?食管异物为耳鼻咽喉科常见的急诊之一,多见于老年人及儿童,应及时就诊,延误治疗可引起一系列并发症。     

Foley catheter extraction of blunt esophageal foreign bodies

The case is reported of a successful Foley catheter extraction of two superimposed coins from the esophagus of an 8-year-old girl. The presence of the second coin was suspected only on review of the lateral cervical radiograph. In a previous report, failure to initially diagnose the presence of an additional coin resulted in an endoscopic failure to clear the esophagus. The technical aspects of Foley extraction are reviewed along with the controversy surrounding the procedure. Series totaling 294 cases document a cumulative success rate of 85% without significant complications. The technique, when performed by airway experts, is concluded to be a viable alternative to endoscopic removal. Lateral films, fluoroscopic extraction, and barium studies in select cases are recommended as safeguards against missing nonobvious foreign bodies of the esophagus.     

Clinical outline of Barrett's esophagus

Barrett's esophagus is one of the important gastrointestinal disease in Europe and the United States. It was recognized as not only complication of reflux esophagitis, but also pre-malignant lesion of adenocarcinoma. Recently, realization of Barrett's esophagus is attentioned in Japan, because increasing of reflux esophagitis for westernization of eating habit, living habit and aging of the population. In this section, we present general consideration and clinical research of Barrett's esophagus. We expect Barrett's esophagus will gradually increase near the future and need to research abundantly about controversial point of Barrett's esophagus. We also think it is important to accumulate intensively the clinical data of Barrett's esophagus patients.     

纽扣电池所致儿童食管损伤的临床特征及治疗

目的探讨纽扣电池所致儿童食管损伤的临床特征及治疗方法,旨在提高儿童纽扣电池食管异物的诊断和治疗水平。方法回顾性分析15例纽扣电池食管异物患儿的临床特征、治疗方法及预后。结果硬质食管镜取出纽扣电池12例,电子胃镜下取出纽扣电池3例。12例患儿发生比较严重的食管损伤,10例患儿通过鼻饲、抗炎及支持治疗得到完全恢复。2例术后发生食管穿孔,其中1例并发食管气管瘘。结论纽扣电池嵌顿在食管容易造成严重食管损伤,处理关键是尽快确诊。一旦确诊纽扣电池嵌顿在食管,必须将其取出。纽扣电池在X线片上有比较明显的特征,胸片可作为误吞纽扣电池诊断首选检查。如能根据病情选择合适的手术方式及恰当的术后处理,多数预后良好,但要警惕食管穿孔及食管气管瘘等严重并发症出现。     

特殊类型食管异物的处理

目的：探讨特殊类型食管异物安全、有效、方便的处理方法。方法：回顾分析1997年1月～2002年6月收治的12例特殊类型食管异物(带金属钩义齿10例，剃须刀1例，金属玩具小飞机1例)的处理过程。结果：5例义齿开胸取出；3例义齿剖腹胃内取出；1例义齿、1例剃须刀、1例金属玩具小飞机异物食管镜取出，1例义齿电子胃镜取出。11例治愈，1例死亡。结论：特殊类型食管异物应尽早尽快手术取出，术前应明确异物种类、取出难易程度、做好应变准备，先行食管镜和电子胃镜试取，试取时宜选择全身麻醉试取失败后应向下推入胃内，剖腹胃内取出异物；下推失败后应尽快开胸取出异物     

A new method for extracting wooden foreign bodies from the upper esophagus

A foreign body impacted in the esophagus is an emergency case that requires immediate treatment. Often the foreign body can be removed easily using forceps or loops. Sometimes, however, safe grasping and extraction may become very difficult. A patient swallowed a chestnut which then stuck in the upper esophagus. The chestnut was removed with a gynecological instrument with a spiral tip used for myoma fixation. Thereafter this technique was applied to in vitro tests with various kinds of meat and wood. In the clinical case, the chestnut could be removed with the spiral tip of the instrument for myoma fixation, whereas in the in vitro tests it was impossible to grasp meat or cut it into pieces. The removal of foreign bodies, such as wood, with the spiral tip of the instrument for myoma fixation during rigid esophagoscopy is an alternative to extraction with forceps or loops. This method is ineffective for the removal of pieces of meat.