儿童上消化道异物致消化道损伤217例回顾性分析

目的 了解儿童上消化道异物致消化道损伤的临床特点及治疗转归。方法 收集2011年1月至2016年12月行胃镜检查诊断为上消化道异物，且出现消化道损伤的217例患儿的临床资料，回顾性分析其临床特点、胃镜下表现、并发症及转归。结果 217例患儿中，1~3岁患儿占比最高（114例，52.5%）。异物以硬币最常见（99例，45.6%），其次为硬质/尖锐食物（45例，20.7%）及金属（35例，16.1%）。消化道黏膜损伤以溃疡最多见（43.8%），其次为糜烂（33.2%）。纽扣电池较其他异物更易引起食管穿孔（P < 0.01）。食管为最常见受损部位（207例，95.4%）。217例患儿中，24例（11.1%）并发感染；异物致穿孔患儿较异物致溃疡患儿感染发生率明显增高（P=0.003）。217例患儿中，204例（94.0%）内镜下成功取出异物。98例因黏膜损伤较重需住院治疗，予以抗感染、抑酸治疗及鼻胃管肠内营养和/或静脉营养支持治疗。10例患儿自动出院而失访，其余患儿均好转出院。结论 幼儿期为上消化道异物高发年龄段；儿童上消化道常见异物为硬币、硬质/尖锐食物及金属；纽扣电池易造成食管穿孔；消化道黏膜损伤越重继发感染率越高；内镜下异物取出术结合鼻胃管肠内营养等处理患儿预后良好。

Clinical features and prognosis of gastrointestinal injury due to foreign bodies in the upper gastrointestinal tract in children: a retrospective analysis of 217 cases

Objective To study the clinical features and prognosis of gastrointestinal injury caused by foreign bodies in the upper gastrointestinal tract in children.Methods A retrospective analysis was performed for the clinical data of 217 children who were diagnosed with foreign bodies in the upper gastrointestinal tract complicated by gastrointestinal injury by gastroscopy from January 2011 to December 2016, including clinical features, gastroscopic findings, complications, and prognosis.Results Among the 217 children, 114 (52.5%) were aged 1-3 years. The most common foreign body was coin (99/217, 45.6%), followed by hard/sharp-edged food (45/217, 20.7%) and metal (35/217, 16.1%). The most common gastrointestinal mucosal injury was ulceration (43.8%), followed by erosion (33.2%). Compared with other foreign bodies, button cells were signifcantly more likely to cause esophageal perforation (P < 0.01). The esophagus was the most commonly injured organ (207/217, 95.4%). Of all the 217 children, 24 (11.1%) experienced infection. The children with perforation caused by foreign bodies had a significantly higher incidence rate of infection than those with ulceration caused by foreign bodies (P=0.003). Of all the 217 children, 204 (94.0%) underwent successful endoscopic removal of foreign bodies. Among these children, 98 were hospitalized due to severe mucosal injury and were given anti-infective therapy, antacids, and supportive care including enteral nutrition through a nasogastric tube and/or parenteral nutrition. Of all the children, 10 left the hospital and were lost to follow-up, and all the other children were improved and discharged.Conclusions Most cases of foreign bodies in the upper gastrointestinal tract occur at 1-3 years of age. Coin, hard/sharp-edged food, and metal are the most common foreign bodies. Button cells are more likely to cause esophageal perforation. The incidence rate of secondary infection increases with the increasing severity of gastrointestinal mucosal injury. Children undergoing endoscopic removal of foreign bodies and enteral nutrition through a nasogastric tube tend to have a good prognosis.