颈侧切开术在嵌顿性食管异物取出术的临床应用

目的探讨颈侧切开术治疗较大的嵌顿性食管异物的适应证及临床诊疗要点,提高对食管异物的诊治水平。方法对2009年5月-2012年5月收治的23例采取颈侧切开入路行食管异物取出术患者的临床资料进行回顾性分析,包括发病时间、异物种类及形状、手术方法等。结果 23例食管异物患者均经颈侧切开手术治疗,无食管穿孔、食管周围炎等并发症发生,术后1周内均顺利出院。结论对于食管上段较大的嵌顿性异物,颈侧切开入路可扩大手术视野,减少手术盲区,避免食管壁的不规则损伤及防止并发症的发生。     

内镜下上消化道异物取出术的配合及护理

目的总结内镜下取出上消化道异物的配合及护理体会。方法全面评估患者情况，进行必要的心理护理及术前准备，根据异物的性质和状态选取合适的器械，密切配合医生开展异物取出术。结果68例患者中，67例成功取出，1例由消化道排出。结论内镜下上消化道异物取出术操作简单、安全、创伤小、成功率高。     

外科医师监护下胃镜高危食管异物取出术的护理

目的探讨外科医师监护下胃镜高危食管异物取出术的效果及护理。方法做好详细的术前指导和心理护理,使患者积极配合手术;术前备好内镜设备、器械,抢救物品及可能需要的外科手术器械;与医师默契配合。操作时动作忌粗暴,应使用巧劲尽快取出异物;术后要严密观察患者病情变化,发现并发症应及时处理。结果13例患者异物均取出,成功率为100％。术后食管损伤或溃疡8例,出血1例,食管穿孔4例。其中12例治愈出院,术后随访1～3个月,未见并发症发生;1例合并纵隔感染转外科治疗后自动出院。结论周到的心理护理及术前准备、术中密切配合、术后仔细观察病情是手术成功的保障。     

透明帽辅助内镜下食管异物治疗术的疗效分析

目的比较透明帽辅助内镜下食管异物取出术及传统内镜下异物取出术的疗效差异。方法选取96例食管异物嵌顿患者随机分成两组,分别施行透明帽辅助内镜下异物取出术(简称透明帽组)或传统内镜下异物取出术(简称传统组),收集两组患者各项临床资料,同时记录其接受内镜下治疗的成功情况、内镜下操作时间、内镜下视野清晰度以及并发症发生情况等数据并进行统计分析。结果接受透明帽辅助内镜下异物取出术的48例患者,均成功完成异物取出治疗,另外48例接受传统内镜下异物取出患者中有46例成功,另外2例转为透明帽辅助下异物取出后成功(成功率95.83%),两组的成功率比较差异无统计学意义(P0.05);透明帽组的平均内镜下操作时间为(8.29±2.83)min,传统组的平均内镜下操作时间为(10.69±3.19)min,两组比较差异无统计学意义(P0.05);内镜下视野清晰度方面,透明帽组视野清晰度A级45例,B级3例,传统组视野清晰度A级35例,B级11例,C级2例,两组间比较差异有统计学意义(P=0.020);所有96例患者均未出现严重出血、穿孔及死亡等并发症。结论透明帽辅助内镜下食管异物取出术是一种安全有效的内镜下异物治疗方案,其可提供更好的内镜下操作视野,有利于提高手术成功率,值得进一步推广应用。     

胃镜下钳取食管异物的护理配合

目的：将异物从食管内取出，以减轻病人痛苦。方法：按常规插人胃管，用异物钳或圈套器等器械，从食管内钳取异物。结果：42例患者中，其中39例顺利取出，一例由于嵌顿时间过长过紧未能取出，二例为监狱罪犯吞服刀片较锋利，加上病人不予配合未能取出。结论：内镜下钳取异物是解除病人误吞异物的有效方法，此法效果好，成功率高。     

25例食管异物嵌顿的内窥镜诊治

我院 1996～ 1999年对 2 5例食管枣核嵌顿的患者进行了内镜诊治 ,所有嵌顿异物均顺利取出 ,现报告如下。1　临床资料2 5例中 ,男 9例 ,女 16例 ,除 1例 6岁儿童外 ,其他 2 4例均为 63～ 82岁老年人。异物嵌顿至内镜诊治时间 6～ 78ｈ。异物嵌顿部位 ,食管入口处 (第 1个狭窄 ) 18例 ,距门齿 2 3～ 2 5ｃｍ处 (第 2个狭窄 ) 7例。所有病例病史相同 ,发病季节相同 ,嵌顿异物相同。均是在每年端阳节前后进食包有红枣的粽子时不慎将枣核嵌入食管的。2　治疗方法及结果2 4例老年患者用 2 %利多卡因胶浆局部麻醉 ,1例儿童因不能配合 ,采用氯安酮分…     

经内镜取上消化道难取有风险异物技巧

目的 探讨经内镜取上消化道难取有风险异物的技巧。方法 用自制的内镜前端保护套、胆道碎石器、双活检管道治疗内镜、胃镜外套管及静脉麻醉等方法治疗如刀片、玻璃、义齿等难取有危险或不能配合的患者的上消化道异物72例。结果 除1例较大联体义齿嵌顿于食管壁，经内镜未能取出改外科手术外，其他异物均顺利取出。无并发症发生。结论 随着治疗器械、方法及技术的改进，经内镜治疗上消化道异物的范围愈来愈大。     

无痛胃镜下取80岁以上高龄老年人食管异物的临床体会

目的总结无痛胃镜下成功取80岁高龄患者食管异物的经验和体会。方法使用合适的器械和方法,根据老年人的年龄、身体状况、有无基础病等情况,充分了解所吞异物的形状和特点、所在上消化道位置、异物的方向、旁边脏器的关系、有无感染等,才能将异物顺利的从食管内取出,达到治疗和解除危机的目的。结果 60例经胃镜检查顺利取出异物57例,3例未能取出的患者转胸外科行手术治疗,内镜取出异物成功率95%,未发现严重并发症,多数患者轻度粘膜损伤或渗血。结论无痛胃镜选择合适的取出器械和方法取高龄患者上消化道异物,方法简单,并发症少,成功率较高,是临床上解决高龄患者食管异物的首选方法。     

上消化道异物内镜下取出术患者的心理护理

目的探讨上消化道异物内镜取出术的围术期护理。方法对73例上消化道异物急诊患者内镜取出术诊治中,进行心理分析及疏导,并配合医生进行治疗,术中根据实际情况,利用不同器械,根据异物的形态、大小,于内镜下取出异物,并观察监测及给予饮食指导。结果在护理工作的密切配合下,顺利完成内镜下食道异物取出术,诊治成功率为98％。结论对上消化道异物经内镜取出术的患者,应加强围术期护理,尤其是心理护理,以减轻患者的痛苦,提高诊治成功率,减少术后并发症的发生。     

成年食管异物住院患者的临床分析

目的该研究旨在分析食管内异物住院患者的临床特征、手术方法、相关的并发症、术后住院时间以及多科协作的优势。方法回顾性分析71例食管内异物住院患者,将患者分为两组(A组,误食异物24 h内得到有效治疗;B组,误食异物超过24 h得到有效治疗)。比较两组患者的病历资料、食道异物的种类、并发症和术后住院时间方面的差异。结果最常见的异物为枣核、动物骨头和鱼骨。食管上段异物常见,其中A组比B组更常见。两组间的并发症发生率和术后住院时间存在明显差异。B组患者并发症发生率高,术后住院时间长,多科协作治疗能给患者提供更合适的治疗方法。结论大多数食管内异物能在内镜下取出,24 h内有效的治疗能减少并发症和缩短术后住院时间,消化内科、耳鼻喉科及胸外科多科协作能给患者提供有效安全的治疗。     

内镜下小儿上消化道异物取出术26例的护理

目的总结26例内镜下小儿上消化道异物取出术的护理方法。方法对26例行内镜下上消化道异物取出术的患儿进行护理,术前掌握好适应证、做好术前准备,术中掌握配合技巧、与医生密切配合,术后严密观察患儿病情、重视饮食指导及健康教育。结果 26例上消化道异物患儿中有25例经内镜将异物成功取出,成功率为96%,另1例因贲门部金属丝嵌入肌层未取,转上级医院治疗。25例成功取出异物的患儿均在清醒状态下完成治疗,无1例发生并发症。结论内镜是治疗上消化道异物的首选处理方法,有效的护理是内镜下小儿上消化道异物取出术成功的必要条件,加强健康教育是预防小儿上消化道异物发生的重要措施。     

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.     

Foreign bodies of the upper gastrointestinal tract: current management

The popularity of the flexible esophagogastroduodenoscope prompted us to reevaluate our management of foreign bodies. In this paper we report our experience and update treatment guidelines. In our series (from December 1975 to May 1982), 74 foreign bodies were removed: 12 with the rigid endoscope, 60 with the flexible endoscope, and two surgically. There was no morbidity or mortality. In the age group 1 to 10 years, there were 15 patients, while the age group 11 to 88 years had 59 patients. Although the rigid endoscope is less expensive and has a larger operating channel, the advantages of the flexible instrument are numerous. Foreign bodies of the pharynx and at the level of the cricopharyngeus muscle are best managed with a rigid endoscope; foreign bodies of the esophagus can be managed with rigid or flexible instruments, but are more easily managed with the latter. Foreign bodies of the stomach and duodenum that require removal can be managed only with the flexible panendoscope.     

Foreign body ingestion in children

Because many patients who have swallowed foreign bodies are asymptomatic, physicians must maintain a high index of suspicion. The majority of ingested foreign bodies pass spontaneously, but serious complications, such as bowel perforation and obstruction, can occur. Foreign bodies lodged in the esophagus should be removed endoscopically, but some small, blunt objects may be pulled out using a Foley catheter or pushed into the stomach using bougienage [corrected] Once they are past the esophagus, large or sharp foreign bodies should be removed if reachable by endoscope. Small, smooth objects and all objects that have passed the duodenal sweep should be managed conservatively by radiographic surveillance and inspection of stool. Endoscopic or surgical intervention is indicated if significant symptoms develop or if the object fails to progress through the gastrointestinal tract.     

Emergency endoscopic management of dietary foreign bodies in the esophagus

Objective

We report our experience of endoscopy in the emergency management of dietary foreign bodies.

Methods

One hundred thirty-six patients were admitted to the emergency department (ED) between January 1997 and October 2006 for the endoscopic removal of esophageal dietary foreign bodies. They had a mean age of 47.7 years, and 91 (67%) were women.

Results

Most of the ingested materials (98.5%) were successfully extracted using either flexible or rigid endoscope. The objects most frequently ingested were fish bones (48%) and chicken bones (46%). Most of the objects (84%) were lodged in the upper esophagus. Two patients with irretrievable foreign bodies or complicated perforations were taken to surgery.

Conclusion

Because most of these foreign bodies lodged in the upper esophagus, physicians should take care of this area to avoid secondary injury or complications, especially with sharp bones.     

AN Unusual Presentation of a Chronic Ingested Foreign Body in an Adult

Background

Sore throat is a common complaint for patients presenting to the emergency department (ED). Although most are caused by viral and bacterial sources, an ingested foreign body must be considered in the right patient population. Retained foreign bodies occur in both children and adults. In children, the objects are usually non-food items, whereas adults are more likely to have impacted food boluses. Typically, patients present acutely, and chronic foreign bodies are rare, especially in adults.

Objective

We use an unusual presentation of a retained foreign body in a previously undiagnosed Zenker diverticulum to review ingested foreign bodies and Zenker diverticuli.

Case Report

We report the case of an 82-year-old woman who presented to the ED with a chief complaint of 12 h of worsening pharyngitis and odynophagia. She reported she had a capsule endoscopy performed approximately 4 months earlier during which the device had malfunctioned and no images were transmitted from beyond the esophagus. A soft tissue film of the neck showed the endoscopic capsule retained at the level of the clavicles. Esophagogastroduodenoscopy demonstrated a previously undiagnosed Zenker diverticulum containing the endoscope capsule. This was subsequently removed with laryngoscopy.

Conclusion

Complaints related to sore throat commonly have a simple explanation. Recurrent symptoms and a physical examination inconsistent with common explanations require the differential to be broadened and less common causes considered.     

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.     

上消化道异物89例分析

我院内镜室自2002年起开展上消化道异物电子内镜下取出术,至今共同收治此类病人89例,现总结如下。1资料与方法1.1一般资料上消化道异物患者89例,其中男性45例,女性44例,最大年龄84岁,最小年龄1岁10月,平均年龄52岁,10岁以下病人4例,60岁以上25例,其他患者年龄在20~59岁之间。就     

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。