食管异物110例临床分析

食管异物，是指各种原因导致异物滞留于食管。经常因为患者饮食不慎而误咽异物，如鱼刺、骨片或脱落的假牙等。异物多嵌在食管狭窄处，在第一狭窄即食管人口处多见。如果不能得到及时治疗，就会引起食管周围炎及脓肿等并发症，如果穿破大血管可引起致命性的大出血。     

内镜紧急处理124例老年食管异物

通过试件试验，提示了ＺＧ２５钢疲劳浅裂纹的长度与扩展速率和门槛值的关系，以及扩展速率与应力强度因子幅的变化关系。分析确定了ＺＧ２５钢的浅裂纹最大尺寸。用有效应力强度因子幅，并在其中引进材料的参数，作为裂纹扩展的控制参量，使浅裂纹和长裂纹的数据点处在同一个分布带内，即可用一个关系式来描述浅裂纹和长裂纹的扩展规律。     

急诊内镜治疗食管异物60例

目的报告60例食管异物内镜治疗的经验．方法本组食管异物60例，男32例，女28例．年龄3岁～79岁嵌顿在食管内的异物有：硬质食物块、肉类团块、骨块、金属异物等．均按急诊，应用上消化道纤维内镜治疗，术前用1％的卡因粘膜表面麻醉，精神紧张者肌注安定10g，取左侧卧床，在直视下插入内镜，边仔细观察边缓慢进镜见到异物后，适当注水冲去异物表面的食物残渣或钡剂，使异物充分暴露，看清异物的种类、大小、形态，嵌顿的部位，以及与周围的关系，从而选择清除异物的最好方案取出异物．结果全部异物均及时清除，其中5例在取异物时发现并经病理确诊为食管贲门癌．术中、术后无严重并发症发生．结论应用内镜取食管异物，效果良好，并发症少，并能发现食管肿瘤．     

食管异物的手术治疗

目的 总结食管异物的手术治疗方法.方法食管异物患者27例,均于发病24 h内就诊.9例颈段食管异物中8例经左侧胸锁乳突肌内侧缘切开取出,1例经右侧取出;18例胸段食管异物经右侧第5肋间切开取出.结果 食管异物顺利取出,患者术后8～9 d恢复经口进食.结论已穿透食管的金属异物和食管镜摘除易引起穿孔的尖锐异物均应早期采用手术治疗,根据异物位置确定手术路径.     

老年性食管异物67例处理体会

老年性食管异物并发症发生机会多 ,处理比较棘手。本文对 1999年 7月～ 2 0 0 2年 12月 67例资料完整的老年性食管异物分析报道如下。1　临床资料1 1　一般资料　 67例中男 43例 ,女 2 4例 ,年龄 61～ 82岁 ,平均 ( 68 1± 10 2 )岁 ,病程 5h～ 38d ,平均 ( 3 5± 1 7)d。异物种类 :①尖锐异物 :鱼刺 2 8例 ,动物骨 11例 ,甲鱼骨 3例 ,义齿 2例 ,枣核等植物果核 99例 ;②软组织异物 :动物肉 5例 ,水果肉 3例 ,馄饨 1例 ,蔬菜团块 2例 ;③其他异物 :手表 1例 ,打火机 2例。就诊时临床症状 :咽痛 67例 ,吞咽困难 38例 ,流涎 12例 ,恶心呕吐 1…     

老年食管异物225例临床分析

目的为了更好地诊断和治疗老年食管异物，防止误诊、漏诊和并发症。方法对１９７１～１９９６年２５年间经治的老年食管异物２２５例进行回顾性研究。结果２１８例异物经食管镜取出，１例取异物过程中滑入胃由肛门排出，２例自动呕出，４例经颈径路切开食管取出，１例食管镜取异物后并发食管穿孔，后继发纵隔脓肿死亡，１例食管癌合并异物食管镜取异物后肺大疱破裂，并发气胸、频发性室早和心肌损害。结论对老年食管异物必须注意心肺功能，警惕食管癌合并异物，通常以局麻取异物较为安全，但对特殊异物以全麻为宜     

小儿食管异物并发症的相关性研究

目的 探讨小儿食管异物嵌顿后易发并发症的相关因素。方法 2012年1月至2015年6月,在西安市儿童医院行内镜下食管异物取出术的150例患儿纳入回顾性分析。相关临床指标（患儿性别、年龄,异物嵌顿部位、嵌顿时间、大小、尖锐程度、性质,并发症严重程度等）行统计学分析。结果 Spearman秩相关分析发现患儿年龄与食管异物并发症的发生呈明显负相关关系（r=-0.187,P=0.022）,异物嵌顿时间（r=0.456,P＜0.001）、尖锐程度（r=0.384,P＜0.001）及性质（r=0.234,P=0.004）与并发症的发生呈明显正相关。多分类有序反应变量的非条件Logistic回归分析发现,嵌顿时间≥8 h的并发症发生风险是＜8 h的9.507倍（95％CI：2.982～30.309）,有钝角／尖锐异物的并发症发生风险是光滑的142.751倍（95％CI：13.736～1 483.562）。结论 小儿食管异物并发症的发生及严重程度与患儿的年龄、异物嵌顿时间、异物尖锐程度密切相关。对于年龄小于1岁的儿童,异物嵌顿时间大于8 h或有钝角／尖锐的更应受到重视,尽早诊断及积极治疗至关重要。     

院前急救对食管胃静脉曲张大出血患者近期预后的影响

目的探讨院前急救对食管胃静脉曲张大出血(esophageal and gastric variceal bleeding,EGVB)患者近期预后的影响。方法回顾性分析秦皇岛市第一医院2011年1月-2013年12月收治的EGVB患者174例,按就诊方式分为院前急救组(观察组)和自行来院组(对照组)。观察组86例:经院前止血、补液等现场急救后,转运入院;对照组88例:未经院前急救,自行或家属护送入院。两组入院后后续用药及治疗均相同,比较两组临床疗效、并发症情况。结果观察组与对照组自救反应时间、平均止血时间相比,差异无统计学意义(P0.05);观察组第一处置时间、输血量、住院天数均少于对照组,差异有统计学意义(P0.01);观察组死亡率13.9%,对照组15.9%,两组比较,差异无统计学意义(P0.05),但观察组肝性脑病、肝肾综合征、感染等并发症发生率(25.6%)明显低于对照组(39.8%),差异有统计学意义(P0.05)。结论对EGVB患者实施迅速有效的院前急救,能提高临床疗效,减少并发症,改善患者近期预后。     

老年食管癌相关性食管异物31例临床分析

我科 1981年 7月至 1998年 12月共收治 6 0岁以上老年食管癌 (包括原来确诊与未确诊、治疗与未治疗过的食管癌病人 )并发食管异物 31例 ,占同期老年食管异物 14 2例的 2 1 8% ,分析报道如下。1　临床资料1 1　一般资料　 31例中 ,男 17例 ,女 14例 ,计 42例次。初次患病年龄 6 0～ 82岁 ,平均 6 8岁 ,其中 6 0～ 6 9岁 17例 ,70～79岁 11例 ,80岁以上 3例。异物停留时间 :1ｄ内 11例次 ,2ｄ 2 0例次 ,3～ 5ｄ 8例次 ,6～ 15ｄ 3例次。1 2　异物种类及停留部位　杨梅核 14例次 ,蔬菜类 11例次 ,猪肉 11例次 ,鸡肉4例次 ,动物内脏 2例次。异物…     

Effect of spasmolytic drugs on esophageal foreign bodies

Muscle spasm has been proposed as the cause for esophageal food impaction. The aim was therefore to treat esophageal foreign bodies with spasmolytic drugs influencing both striated and smooth muscles of the esophagus. A multicenter, placebo-controlled, doubleblind study of glucagon and diazepam was undertaken in 43 patients. The foreign body disimpacted in 9 of 24 patients given active substances and in 6 of 19 patients given placebo; there was no significant difference between these two groups. Almost all disimpactions occurred several hours after injection of the drugs. The hypothesis of muscle spasm as an important cause of esophageal obstruction was rejected. Medical therapies for food disimpaction other than spasmolytic drugs have to be investigated.     

Removal and management of esophageal foreign bodies

Esophageal foreign bodies and food bolus impaction occur frequently and are a common endoscopic emergency. Though the vast majority of gastrointestinal (GI) bodies do not result in serious clinical sequelae or mortality, it has been estimated that 1500-2750 patients die annually in the United States because of the ingestion of foreign bodies. More recent studies have suggested the mortality from GI foreign bodies to be significantly lower, with no deaths reported in over 850 adults and 1 death in approximately 2200 children with a GI foreign body. As a result of the frequency of this problem and the rare but possible negative consequences it is important to understand the best method for diagnosis, the patients in need of treatment, and the correct techniques for the management of GI foreign bodies. Flexible endoscopy has become the diagnostic and treatment method of choice for both esophageal food impaction and true esophageal foreign bodies because of high success rates and low complication rates. This review covers and focuses on the techniques needed to diagnose and effectively treat esophageal food impaction and true foreign bodies     

Endoscopic management of impacted esophageal foreign bodies

There are many reports on the endoscopic management of ingested foreign bodies in the upper gastrointestinal tract, however, little is known about the management of a specific subset of esophageal foreign bodies – impacted esophageal foreign bodies (IEFBs), especially perforating esophageal foreign bodies (PEFBs). The aim of this retrospective study on 78 cases was to report experience and outcome in the endoscopic management of the IEFBs in Chinese patients. From January 2006 to July 2011, a total of 750 patients with suspected upper gastrointestinal foreign bodies were admitted to the endoscopy center. Among these 750 patients, 78 cases that met the defined criteria of IEFBs were retrospectively enrolled in the present study, including 12 cases (12/78, 15.4%) with PEFBs. The major types of IEFBs were poultry bones (35.9%) and fish bones (17.9%). Most of the IEFBs (80.8%) were located in the upper esophagus, as were two thirds (66.7%) of the PEFBs. Foreign‐body retrieval forceps were the most frequently used accessory devices. Extraction of IEFBs failed in eight patients (10.3%) during the endoscopic procedure. The difficult points in endoscopic management were PEFBs, IEFBs with sharp points, and those with impaction for more than 24 hours. IEFBs should be treated as early as possible, and their endoscopic management is safe and effective. Endoscopic management is the first choice for PEFBs when the duration of impaction is less than 24 hours and there are no abscesses outside of the esophageal tract as determined by a computed tomography scan.     

成年患者食管异物临床特点分析256例

目的:总结分析食管异物患者临床特点.方法:对2004-01/2012-01消化内镜中心诊治的食管异物成年患者进行回顾性分析,并对其临床资料特点进行统计分析.结果:共纳入256例患者,食管异物以食源性异物为主(95.7%),常见临床症状为异物梗阻感、吞咽困难、吞咽疼痛.老年患者(≥65岁)伴有食管基础疾病的比例明显高于18-65岁患者(27.6%、14.8%,P<0.05).有食管基础疾病的患者,异物以食糜为主(65.3%).而无食管基础疾病的患者异物以鱼骨、鸡骨等骨头为主(68.5%),对比有统计学差异(P<0.05).252例患者(98.4%)经内镜下治疗成功.结论:食管异物为临床常见疾病之一,治疗过程中需注意老年患者和/或有食管基础疾病的患者.内镜下治疗食管异物安全有效.     

Association between the visiting time and the clinical findings on admission in patients with acute heart failure

BackgroundThere have been few reports about the clinical significance of the time of admission for acute heart failure (AHF).MethodsFive hundred thirty-one patients with AHF admitted to the intensive care unit (ICU) were analyzed. The patients were assigned to either the daytime HF group (n = 195, visited from 08:00 to 20:00, Group D) or nighttime HF group (n = 336, visited from 20:00 to 08:00, Group N). The clinical findings and outcomes were compared between these groups.ResultsThe systolic blood pressure (SBP), the number of patients with clinical scenario (CS) 1, and the heart rate (HR) were significantly higher in group N (SBP, 171.0 ± 38.9 mmHg; CS 1, 80.9%; HR, 116.9 ± 28.0 beats/min) than in group D (SBP, 154.2 ± 37.1 mmHg; CS 1, 66.2%; HR, 108.6 ± 31.4 beats/min). The patients in group N were more likely to have orthopnea (91.1%) than those in group D (70.3%). A multivariate logistic regression model identified a SBP ≥164 mmHg [odds ratio (OR): 2.043; 95% confidence interval (CI): 1.383–3.109], HR ≥114 beats/min (OR: 1.490; 95%CI: 1.001–2.218), and orthopnea (OR: 2.257; 95%CI: 1.377–3.701) to be independently associated with Group N. The length of ICU stay was shorter in group N (5.8 ± 10.5 days) than in group D (7.8 ± 11.5 days).ConclusionThe nighttime HF was characterized by high SBP, high HR, and orthopnea, and the length of ICU stay was shorter in the nighttime HF group.     

Treatment of cervical esophageal perforation caused by foreign bodies

In this article, we reviewed our experience of treatment of cervical esophageal perforation caused by foreign bodies. Between 1980 and 2010, 42 patients were included in this study. There were 18 women and 24 men with a median age of 54 years. We divided the patients into three groups: the patients whose foreign bodies could not be extracted by otolaryngologists using endoscope (n= 7), the patients who had some signs of abscess formation but the foreign bodies had been extracted using endoscope (n= 25), and the patients who had no signs of abscess formation and the foreign bodies had been extracted (n= 10). We treated the patients of the three groups with surgical treatment, drainage alone, and conservative treatment, respectively. The outcome of the current series was favorable. Our experience suggested that most of the cases can be treated conservatively or by drainage alone. If the foreign bodies of the esophagus could not be extracted using endoscope, surgical treatment including the removal of the foreign bodies, primary repair, and drainage should be performed.     

Management of esophageal foreign bodies: experience of 90 cases

Background

In Japan, there have been few recent reports of large-scale studies on the characteristics and optimal treatment of esophageal foreign bodies.

Methods

We analyzed data on 90 patients diagnosed as having esophageal foreign bodies treated between April 2002 and August 2007.

Results

In children younger than 15 years (n = 13), the types of foreign bodies included coins (n = 9), food (n = 1), and other objects (n = 3), 12 of which were successfully removed without endoscopic procedures; in the remaining 1 case, the object advanced to the lower digestive tract spontaneously. In adults aged 15 years or older (n = 77), the types of foreign bodies included food-bolus impaction (n = 26), press-through packages (n = 18), fish bones (n = 14), dental prostheses (n = 13), and other objects (n = 6). The foreign bodies had advanced to the lower digestive tract in 4 patients at the time of flexible endoscopy performed under topical pharyngeal anesthesia. In 6 of the remaining 73 patients, the first endoscopic extraction was unsuccessful, and 5 of these cases involved dental prostheses. The mean maximal size of the dental prosthesis was significantly greater in patients in whom removal was unsuccessful than in those in which it was successful (5.8 versus 1.6 cm, respectively; P < 0.05). The procedures employed following unsuccessful endoscopy included thoracotomy (n = 1), laparotomy (n = 1), removal by forceps under direct vision (n = 1), and rigid (n = 1), and flexible endoscopy (n = 2) under general anesthesia.

Conclusions

The majority of esophageal foreign bodies were successfully removed nonendoscopically in pediatric patients and endoscopically in adult patients. Endoscopic removal under topical pharyngeal anesthesia may not be indicated for patients who have swallowed large dental prostheses.     

内镜头端透明帽辅助食管上段异物治疗的对照研究

目的通过比较非镇静状态下透明帽辅助治疗与常规内镜治疗前、治疗中2 min时血压、脉搏、血氧饱和度的动态变化,作呕反应程度,治疗完成时间,食管黏膜损伤情况和视野清晰度,以评价内镜头端透明帽辅助食管上段异物取出的可行性、安全性、有效性和耐受性。方法将144例患者随机分为透明帽辅助治疗组(72例)和常规内镜治疗组(72例);分别监测患者检查前、检查中2 min时的血压、脉搏、血氧饱和度,作呕反应程度,治疗完成时间,食管黏膜损伤情况和视野清晰度。结果透明帽辅助治疗组的血压、脉搏、血氧饱和度变化与常规内镜治疗组比较差异无统计学意义(P>0.05);透明帽辅助治疗组的视野清晰度明显高于常规内镜治疗组(P<0.01);透明帽辅助治疗组的治疗完成时间、作呕反应、黏膜损伤率均低于常规内镜治疗组(P<0.05)。结论内镜头端透明帽辅助食管上段异物治疗是一种可行、安全、有效的治疗方法,并具有较好的耐受性。