儿童纽扣电池食管异物临床治疗

目的　分析儿童纽扣电池食管异物临床诊断、治疗及预后特征,为纽扣电池类食管异物临床处理提供参考。方法　选取本院2016年4月~2018年5月收治的341例食 管异物中8例纽扣电池食管异物的患儿,结合纽扣电池大小、嵌顿时间、术中食管黏膜损伤情况及预后,综合分析纽扣电池类食管异物的临床特征。结果　8例患儿均为学龄前儿童;最短异物嵌顿时间3小时20分钟,最长243小时35分钟;7例异物位于食管第一狭窄,1例位于食管第二狭窄;食管黏膜轻度充血水肿1例;黏膜明显烧伤4例;食管狭窄,可疑穿孔1例;食管穿孔1例;气管食管瘘1例。术后胃肠减压最短3天,最长12天,1例气管食管瘘予空肠营养127天后治愈。结论　儿童纽扣电池类食管异物需急诊手术取出,门急诊需警惕纽扣电池类食管异物;术中需仔细检查食管黏膜损伤情况,并彻底清洗创面;术后并发症种类较多,需密切观察和积极对症治疗。     

儿童纽扣式电池食管异物分析

目的　总结儿童纽扣式电池食管异物临床表现,探讨其安全、有效的治疗方法。方法　回顾性分析我院2014年4月～2016年12月收治的误咽纽扣式电池患儿12例,其中1例异物位于食管第二狭窄,其余11例均位于食管第一狭窄。结果　8例经食道镜取出,1例电子胃镜取出,1例经电子胃镜取出困难,改行食道镜取出,1例采用Foley管取出,1例Foley管取出困难进一步行食道镜取出。9例并发食管周围炎,食管腐蚀伤,2例并发食管穿孔,1例并发食管气管瘘。结论　食管异物为小儿常见急诊,其中纽扣式电池对人体的危害极大,纽扣式电池含有重金属及化学化合物,对食管壁具有腐蚀性,造成食管壁的损伤,伴发食管穿孔、狭窄等,损伤程度与异物嵌顿时间成正比,及时采取合理的手术是治愈的关键。     

儿童扣式电池食管异物临床分析

目的:提高小儿扣式电池食管异物的诊断和治疗水平。方法:分析4例扣式电池食管异物患儿的临床资料。结果:4例患儿因诊断时间、手术时机不同,1例死亡,3例治愈。结论:扣式电池食管异物临床报道少见,因扣式电池为碱性,腐蚀性强,危害大,临床应该引起重视。及时诊断、及时合理手术是治愈的关键。     

儿童食管异物42例临床分析

目的探讨非常见儿童食管异物的诊治经验。方法回顾性分析42例儿童非常见食管异物的临床资料,所有病例均行全麻硬性食管镜下异物取出术,5例术中应用潜窥镜。一例食管电池异物合并胃底电池异物的患儿,在硬食管镜下取出食管内电池后,在胃镜下顺利取出胃底部电池。结果42例患儿均成功取出异物。结论儿童食管异物,确诊后尽早手术;全身麻醉是确保尖锐性食管异物成功取出的关键及安全保障。要特别重视纽扣电池等腐蚀性异物,术后需要延长禁食时间。术中应用潜窥镜,能提升手术的安全性和成功率,同时可减少食管异物相关并发症的发生。     

关于进入胃内异物的转换期

进入胃内的异物有时不能用内腔镜取出。如认为胃内异物都能经消化道顺利排出,这种观点是危险的。本文分析岩手医大耳鼻喉科13年间消化道异物321例,其中食管异物198例,胃异物79例,肠异物44例。198例食管异物中经内腔镜取出者167例,吐出15例,内腔镜检查前或术中进入胃内者15例,镜检前食管破裂死亡者1例。     

消化道内巨大金属异物自愈1例

患者男 ,70岁。误咽犁铁块 2小时余。有吞咽痛 ,X线检查见食管第一狭窄稍下有一 4.5 cm× 4.0 cm不规则梯形金属异物 ,铁块厚约 0 .7cm。经食管镜取出术 ,反复钳取异物终因异物太大而未取出 ,又因食管粘膜损伤、出血 ,故将患者转入本市一家大医院住院治疗 ,表麻取异物亦未成功 ,动员患者开胸取异物 ,患者因恐惧而出院回家。 2天后患者自觉症状缓解 ,来我院行 X线检查 ,发现异物存留于胃内。 10天后复诊 ,行 X线检查见异物存留于横结肠 ,3周后金属异物经肛门排出。随访 6年该患者饮食、二便均正常。消化道内巨大金属异物自愈1例@王选胜!116…     

儿童鼻腔扣式电池异物的治疗与临床观察

目的探讨鼻腔扣式电池异物对鼻腔黏膜的损害及其治疗方法,预防并发症。方法 12例全部在局麻加制动的方法下取出鼻腔扣式电池,然后鼻腔冲洗、换药等综合治疗。结果 12例经过综合治疗后恢复,仅1例并发鼻中隔穿孔。结论鼻腔扣式电池异物取出后局部进行冲洗、换药等综合治疗,可使腐蚀而糜烂的鼻黏膜得以恢复,有效地防止鼻中隔穿孔。     

鼻腔扣式电池异物34例

目的:探讨预防鼻腔扣式电池异物并发鼻中隔穿孔的方法.方法:对34例鼻腔扣式电池异物患者资料进行回顾性分析,28例在全身麻醉下,6例在局部麻醉下取出异物.取出鼻腔扣式电池后25例局部经冲洗、换药治疗,另9例未行任何治疗.结果:34例中25例经过继续治疗并发鼻中隔穿孔 1例,其余9例未经过继续治疗均并发鼻中隔穿孔.结论:取出异物后进行局部冲洗、换药,修复腐蚀糜烂的鼻黏膜,黏膜糜烂得到有效的控制,使腐蚀面积不再扩大,有效防止并发鼻中隔穿孔.     

全身麻醉下食管异物取出术523例

目的：探讨患儿在全身麻醉下食管异物取出术中行鼻咽腔检查的必要性。方法：回顾我科自1980年以来对523例患儿在全身麻醉下行食管异物取出术的临床资料,分析其手术失败的原因。结果：本组共行手术523例,其中508例(97．1％)术中取出异物,10例(1．9％)异物滑入胃内,48h内经大便排出;5例(1．0％)全身麻醉后异物滑落至鼻咽腔,食管镜检查未见异物,后经2次手术或在全身麻醉喉镜下将异物取出。结论：患儿在全身麻醉下,由于食管肌肉松弛,加上重力作用,食管异物容易发生移位,滑落至鼻咽腔内,尤以食管入口处异物为甚。因此,对术前检查异物征阳性而术中未见异物者,应常规在全身麻醉喉镜下检查口咽及鼻咽腔,以防漏治。     

Foley管在儿童圆钝食管异物取出术中的应用

目的 探讨应用Foley管取出儿童食管异物的有效性和安全性。方法 回顾性分析深圳市儿童医院耳鼻咽喉科近5年共496例儿童使用Foley管取出食管异物的手术方式、手术效果及并发症。结果 496例患儿中440例经Foley管法取出;56例未能取出,其中49例复查X线检查发现异物进入下消化道经粪便排出,另外7例住院全麻下行硬质食管镜取出异物。所有患儿术后无食管穿孔、感染、误吸异物等并发症。结论 Foley管法取出异物安全、高效、便捷、实用性强,在儿童圆钝食管异物治疗中具有明显的优越性。但异物嵌顿时间越长,嵌顿于食管中下段以及非硬币类圆钝异物取出成功率较低。     

婴幼儿复杂食管异物诊治分析

目的 探讨婴幼儿复杂食管异物的诊治经验.方法 回顾性分析我院耳鼻咽喉科2002年1月～2010年12月70例复杂婴幼儿食管异物的临床资料,所有病例均行全麻硬性食管镜下异物取出术,5例术中应用Hopkin's潜窥镜.其中异物为纽扣电池者6例,同时合并有食管瘢痕者10例,对2例食管异物取出术后出血者,局部填塞速即纱(SUR...     

颈侧切开术治疗异物穿孔并纵隔脓肿6例

目的：探讨颈侧切开术治疗异物穿孔并纵隔脓肿患者的适应证及临床诊疗要点。方法i6例异物穿孔并纵隔脓肿患者均在入院后12h内行颈侧切开术。结果i6例患者中,4例取出异物;1例入院前已在当地医院取出异物;1例未找到异物。除1例声嘶、术后1年恢复外,余均无并发症。结论：异物穿孔并纵隔脓肿是颈侧切开术的适应证。     

颈侧切开在颈段食管异物取出中的应用

目的 探讨颈侧切开术治疗颈段食管异物的适应证及诊治要点.方法 回顾性分析1999年1月至2009年1月治疗2189例食管异物患者中137例(6.25%)行颈侧切开术患者的临床资料,其中16岁以上成人组114例,16岁以下未年组23例.成人中食管穿孔67例(58.8%);食管未穿孔患者47例,其中7例合并有食管周围脓肿.未成年人中食管穿孔19例(19/23);食管末穿孔但合并食管周围脓肿3例,未形成脓肿的巨大异物1例.结果 137例异物患者经颈侧切开手术治疗后均痊愈出院.19例(13.9%)患者出现声嘶,3个月内均恢复.成人组5例(3.6%)患者术后出现轻度颈段食管瘢痕性狭窄,行扩张治疗3～11个月完全恢复;9例穿孔食管行二期缝合后穿孔愈合,其余食管穿孔均一期愈合;1例颈总动脉受损行结扎术后患者未出现偏瘫、失语等后遗症;9例气管切开患者中7例住院期间拔除气管套管,2例肥胖患者中1例出院后3个月拔管,1例带管至今.未成年组穿孔食管术中对位缝合后均一期愈合;5例气管切开患儿均拔管.结论 贯穿性食管异物及颈部脓肿是颈侧切开术的适应证,积极防治颈侧切开手术的并发症及合并症,可获得较好疗效.     

复杂性食管异物的临床诊疗分析

目的 探讨复杂性食管异物伴发严重并发症的种类及特点,总结其临床诊断及治疗方法。 方法 对广东医科大学附属医院2015年1月至2018年1月住院治疗的244例食管异物中22例伴有严重并发症的患者资料进行回顾性分析,包括发患者群、就诊时间、异物类型及嵌顿位置、并发症类型及诊断治疗方式等。 结果 22例中除4例儿童外,其余患者均在发病后通过进食馒头、蔬菜、努力吞咽等方式,试图将异物强行推入胃中未果,从而出现严重并发症;从发病到就诊最长达32 d,平均5.9 d;误吞异物类型中17例(77.3%)为动物性骨头,以鱼骨和鸡骨为主;10例嵌顿于食管入口水平,5例嵌顿于T1-T2水平,3例嵌顿于T8-T9水平;严重并发症包括食管穿孔或合并食管局部炎症6例(27.3%),颈部及纵隔气肿、脓肿5例(22.7%),食管纵隔瘘4例(18.2%),游走于食管外异物3例(13.6%),咽后壁脓肿1例(4.5%),气胸1例(4.5%),气管食管瘘1例(4.5%),食管主动脉瘘1例(4.5%);14例于食管镜下取出异物,3例经颈侧切开探查取出异物,3例同时行颈部及纵隔脓肿切开引流术,1例行食管镜+胸腔镜探查,并行肺大泡切除术,1例行支气管镜异物取出术+气管食管瘘修补术;22例患者中治愈21例(95.5%),平均住院时间为6.2 d,死亡1例(4.5%)。 结论 复杂性食管异物多见于老年患者,多因发生异物嵌顿后患者错误的暴力吞咽方式、不及时就医等不恰当处理方法,导致了患者病情的延误。异物的类型、嵌顿位置及就医时间与并发症的产生及严重程度呈正相关,上消化道造影及CT检查是诊断食管异物及其并发症的最有效方法,能够清楚地显示出异物与周围重要组织器官的关系,多学科协助治疗是挽救严重并发症引起危重病情的重要方式。     

The interesting case -- case no. 69

This report presents the case of a 28-year-old patient who was referred to our department for having swallowed a metallic foreign body accidentally. Initial X-ray investigation showed a bent needle, localized in the upper esophagus. While removal of the object in question was being planned, we just in time got information concerning the patient's far-reaching psychiatric history. By interviewing him again it turned out that he had been swallowing multiple bent pins intending to commit suicide. Abdominal X-ray demonstrated at least 12 bent metallic pins in different segments of the gastrointestinal tract. Subsequently the young man was admitted to the local psychiatry department. All foreign bodies were excreted per vias naturales within a few days. This case shows that the ingestion of "atypical" foreign bodies needs very careful anamnesis. The patients' psychiatric background and past history should always be taken into consideration.     

An unusual sharp magnetic foreign body in the oesophagus and its removal: A case report

Ingestion of foreign bodies is a common pediatric problem. The majority of ingested foreign bodies pass spontaneously. Oesophageal foreign bodies should be urgently removed because of their potential to cause complications. Ingested batteries that lodge in the oesophagus, sharp or pointed foreign bodies in the oesophageal or gastric tract, and ingestion of multiple magnets all require urgent endoscopic removal. A 4-year-old boy ingested a sharp magnetic foreign body, which was removed via rigid oesophagoscopy without complication. To the best of our knowledge, this is the only sharp magnetic foreign body ingested by a young child ever reported in the English-language literature. We describe the presentation and therapeutic procedure adopted in this case.     

Analysis of Clinical Feature and Management of Fish Bone Ingestion of Upper Gastrointestinal Tract

Objectives

Fish bone impaction in the upper gastrointestinal tract is a common reason for patients to seek emergent care. The aim of this study was to find a clinical characteristics of patients with fish bone impaction in the upper gastrointestinal tract.

Methods

The study was conducted on 286 fish bone ingestion patients who complained of dysphagia and irritation after eating fish. The patients were treated according to the hospital protocol regarding the removal of fish bone. The parameters for the analysis included the age and sex of the patients, location and characteristics of the foreign body, method of removal, and type of fish.

Results

The fish bone could be observed by the physical examination in the oral cavity and laryngopharynx in 198 patients (69.23%). For those patients in whom the foreign body could not be observed in oral cavity and laryngopharynx, noncontrast computed tomography (CT) (from nasopharynx to diaphragm) was performed. The fish bone was discovered in the esophagus of 66 patients (23.08%). The esophageal fish bone was successfully removed by transnasal flexible esophagoscopy (TNE) in 55 patients, the fish bone moved to the stomach in 10 patients and one fish bone was removed by rigid esophagoscopy due to esophageal abscess. The esophageal fish bone was mostly found in patients aged 50 years and older.

Conclusion

Fish bone foreign body ingestion in the esophagus appeared to be more common in older patients. Incorporating noncontrast CT and TNE can facilitate decision-making and adequate treatment for patients with fish bone impactions.