内镜治疗上消化道异物70例分析

目的对上消化道异物的临床特点及内镜下治疗措施进行分析。方法对1993年10月～2007年1月的70例内镜治疗的上消化道异物患者的资料作回顾性分析。结果70例中内镜下成功取出68例（97．1％），其中34例食管异物成功取出32例（94．1％），21例胃内异物全部取出（100．0％），15例十二指肠异物全部取出（100．0％）。21例尖锐形异物取出19例（90．5％），10例长形异物全部取出（100．0％），39例圆钝形异物全部取出（100．0％）。1例（1．4%）轻微并发症为异物嵌顿处黏膜少量出血。2例未能取出的异物为食管异物。病程超过48h有穿孔并发症迹象，其中1例为鱼骨，1例为塑料药品包装板，后经外科手术治疗成功。结论内镜消化道异物取出术是有效、安全的方法。     

上消化道异物41例胃镜下治疗分析

目的总结上消化道异物的内镜治疗方法及效果。方法对该院2014年10月-2016年5月41例上消化道异物内镜下治疗病例临床资料进行分析。结果上消化道异物中老年患者多见,异物潴留部位多见于食管(53.6%),异物类型以枣核为主(56.1%),41例患者异物均成功取出,合并穿孔1例。结论内镜治疗上消化道异物是一种安全、有效的方法。     

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.     

儿童上消化道异物并发损伤的危险因素分析

目的:探讨儿童上消化道异物的种类、异物所处消化道位置及异物并发的消化道损伤,对儿童发生上消化道异物造成消化道损伤的相关危险因素进行分析,为上消化道异物的诊断及干预提供进一步的资料及依据.方法:选择安徽省儿童医院2018年6月-2021年6月期间因上消化道异物就诊且完善了无痛电子胃镜(胃镜型号为OLYMPUS EG-27...     

Endoscopic ultrasound of the upper gastrointestinal tract

Endoscopic ultrasound (EUS) is an evolving technique used by gastroenterologists to examine lesions that are located either within or adjacent to the walls of the upper gastrointestinal (GI) tract; this topic is relatively unknown to most radiologists. Proper use of this modality is benefited by a cooperative effort between gastroenterologists and radiologists specializing in ultrasound and cross-sectional imaging. This article informs radiologists of the applications of this procedure. Most patients are examined with EUS after a biopsy of a mucosal tumor has been performed. A smaller number are performed to evaluate submucosal masses or when pancreatic disease is suspected but not diagnosed. The examinations can be performed either with dedicated flexible echoendoscopes or with catheter-based probes passed through a conventional endoscope. The exact location of abnormalities associated with the upper GI tract can be observed. Known anatomic landmarks are sought. Abnormalities of structures outside the upper GI tract will occasionally be found during these examinations. The specific layers of the walls of the gut are examined, and the T and N-classification of upper GI tumors can be determined accurately. The performance of an EUS examination requires advanced skills, and in many medical centers, it is the imaging modality of choice to stage cancers, to evaluate submucosal masses, and to investigate both malignant and benign pancreaticobiliary disease. Endoscopic ultrasound is sensitive but not specific, and biopsy is necessary to establish a diagnosis. Therapeutic applications of EUS are evolving. Specialized applications with catheter-based probes are also being developed.     

Endoscopic management of multiple broken scalpel blades in the gastrointestinal tract: a case report

The entry of multiple broken scalpel blades into the gastrointestinal tract with involvement of the stomach, ileum, and colon is rare; no such cases have been reported to date. Whether management of multiple sharp foreign bodies is more effective by endoscopy or surgery remains controversial in clinical practice. We herein describe a 23-year-old man with depression who was admitted to our department 36 hours after swallowing multiple scalpel blades. The patient reported abdominal pain and bloody vomit. A radiograph revealed irregular blade-shaped foreign bodies in the abdomen, and computed tomography confirmed foreign bodies in the stomach, mid-distal segment of the ileum, proximal segment of the ascending colon, liver area of the transverse colon, and lumen of the sigmoid colon. Surgery was immediately suggested as the first-choice treatment, but endoscopy was instead performed after a thorough multidisciplinary discussion. All broken scalpel blades were successfully removed with combined gastroscopy and colonoscopy, and the patient’s postoperative recovery was uneventful. This case demonstrates the vital importance of multidisciplinary management and endoscopy as an appropriate treatment approach even for multiple sharp foreign bodies in patients without perforation or peritonitis.     

上消化道异物急诊内镜处理的回顾性分析

目的展示急诊内镜下上消化道异物取出术的经验及创新的措施。方法该研究回顾性分析2013年1月-2016年11月在该院消化内镜室取出异物的251例患者,患者采取局部麻醉或静脉复合麻醉方法,应用软式内镜和各种内镜附件(鼠齿钳、鳄鱼钳、息肉勒除器、息肉抓钳、取石网篮、碎石器或者碎石工具套装和橡胶手套等)进行诊治。收集患者的一般资料(年龄、性别、异物类型)、麻醉种类、异物崁顿的位置、内镜附件的类型、并发症和成功率。结果 251例患者均通过内镜确诊为消化道异物,248例患者异物被成功取出,3例失败,其中1例患者行胸外科手术,1例行耳鼻喉科手术,1例患者因为没有症状和治疗风险而拒绝行异物取出术。192例有轻微黏膜损伤或出血,45例患者发现潜在疾病。结论急诊内镜下异物取出术是治疗消化道异物的最佳手段,因为其在安全性、有效性、费用低、微创方面有绝对优势,而且内镜治疗时还可以发现潜在消化系统疾病;创新性的手段可提高异物取出成功率。     

Endoscopic management and follow up of Dieulafoy lesion in the upper gastrointestinal tract

BACKGROUND AND STUDY AIMS: Dieulafoy's lesion is an important cause of upper gastrointestinal bleeding, and the safety and efficacy of endoscopic treatment have been widely accepted. The aim of this study was to evaluate the effectiveness of endoscopic management, including hemoclipping and injection methods, for bleeding Dieulafoy lesions in the upper gastrointestinal tract. PATIENTS AND METHODS: Between 1995 and 2003, 61 patients with bleeding Dieulafoy lesions underwent endoscopic treatment. The available hemostatic methods were hemoclipping, hypertonic saline-epinephrine injection, and pure ethanol injection. Clinical data, endoscopic features, and treatment outcome were analyzed retrospectively. RESULTS: Comorbid conditions were present in 39 patients (64 %). Active bleeding was noted in 20 patients (33 %). Hemoclipping was a selected treatment in 48 patients (79 %). Initial hemostasis was achieved in 61 patients (100 %). One patient had rebleeding 6 days after the initial procedure but was successfully treated endoscopically. The 30-day mortality was 0 %. During follow-up, for a mean of 47 months, 15 patients (25 %) died of causes unrelated to the Dieulafoy lesion. Two patients had recurrent bleeding due to non-Dieulafoy gastric ulcer, and responded to endoscopic therapy. We encountered no patients who required surgery. CONCLUSIONS: Dieulafoy lesion can be successfully managed by endoscopic treatment. The long-term outcome is acceptable.     

胃镜治疗小儿上消化道异物45例分析

目的 探讨成人胃镜治疗儿童上消化道异物的临床疗效。方法 采用Olympus GIF-XQ 240胃镜和相关器械对45例误吞异物的儿童进行上消化道取异物治疗。结果 小儿上消化道异物34例取异物获成功，术中、术后无1例出现并发症。结论 成人胃镜治疗儿童上消化道异物的费用低、疗效好、安全性高，值得临床推广。     

42例小儿上消化道异物取出的观察及护理

总结42例小儿上消化道异物取出的观察和护理。根据异物吞入时间及异物大小、性质,19例用排出异物法,21例用胃镜取异物法,2例用手术取异物法,异物均顺利排出或取出,未发生并发症。除对家长及年长患儿做好心理护理外,排出异物法的护理重点是观察患儿的大便中有无异物,患儿出现呕血、腹痛、发热、黑便,须改用其他方法处置;胃镜取异物法损伤性小,并发症少,护理重点是认真做好准备,取异物时严密观察患儿生命体征,取异物后加强观察,注意有无出血、穿孔症状;手术取异物用于异物已致消化道穿孔者,术后予腹部手术的常规护理。     

上消化道异物的特点及其并发症的危险因素分析

目的总结上消化道异物的临床特点并分析其所致并发症的危险因素。方法回顾性分析该院上消化道异物患者的临床资料,研究其并发症发生的危险因素。结果 (1)上消化道异物的类型以枣核多见,异物最常见的部位为食管上段;(2)通过Logistic回归分析得出上消化道异物所致并发症的危险因素为:异物存在的时间≥12 h(OR=9.04,95%CI:2.91~28.04;P=0.000)及边缘锐利(OR=7.95,95%CI:2.09~30.21;P=0.002)。结论异物存在的时间≥12 h及其边缘锐利是上消化道异物导致并发症的危险因素。     

Endoscopic therapy for bleeding from the upper gastrointestinal tract

Advances in endoscopic therapy have dramatically altered the approach to acute upper gastrointestinal tract hemorrhage. It can no longer be assumed that early endoscopic evaluation of this condition does not affect outcome. In the management of selected patients with nonvariceal hemorrhage, endoscopic therapy affects rates of rebleeding, need for surgery and transfusions, and length of hospitalization. For patients with variceal hemorrhage, the impact of endoscopic treatment is less clear. The endoscopic advances of the past decade have been exciting and have presented new challenges. Future investigators need to better define subgroups of patients who will benefit from this technology and determine which of the many techniques available will be safest and most efficacious.     

儿童上消化道异物特点及电子胃镜取出的有效性分析

目的 通过分析不同年龄段儿童上消化道异物特点及临床诊治方法,探讨消化道异物知识普及的必要性及电子胃镜取出的有效性.方法 回顾该院1996-2017年收治的101例年龄小于18岁、行上消化道异物电子胃镜取出的患儿资料,分析上消化道异物性质、嵌顿位置、并发症及电子胃镜治疗的有效性.结果 学龄期(6～<13岁)和学龄前期(3...     

Endoscopic band ligation of Dieulafoy-like lesions in the upper gastrointestinal tract

BACKGROUND AND STUDY AIMS: Endoscopic band ligation (EBL) is currently considered to be the treatment of choice for esophageal variceal bleeding. This study reports on the efficacy and safety of EBL in patients with Dieulafoy-like bleeding lesions in the upper gastrointestinal tract. PATIENTS AND METHODS: Between December 1994 and February 2000, 23 patients with upper gastrointestinal tract hemorrhage (median age 58, range 28-75) were treated using EBL. EBL was used as a rescue therapy in four patients and as the initial treatment in 19 patients. RESULTS: The site of bleeding was the stomach in 10 patients, Billroth II anastomosis in 10, the first part of the duodenum in one, the second part of the duodenum in one, and the jejunum in one patient. Endoscopic band ligation was successful in 22 of the 23 patients. The remaining patient, a young man with a Dieulafoy-like lesion in the jejunum, had recurrent bleeding on day 5 after EBL and underwent elective surgery. CONCLUSIONS: Endoscopic band ligation is an effective and safe endoscopic treatment for Dieulafoy-like lesions. It is easy to use and relatively inexpensive.     

电子胃镜治疗儿童上消化道异物40例临床分析

目的探讨电子胃镜治疗儿童上消化道异物的有效性及安全性。方法对40例儿童(年龄9个月~9岁)上消化道异物行电子胃镜检查与治疗,咽喉部局麻下用Olympus-GIF160电子胃镜进行操作,运用异物钳、篮网器等取异物。结果 40例儿童上消化道异物,局部麻醉状态下全部取出。食管异物30例,胃内异物10例,食管金属夹子2例,食管纽扣电池1例,食管桔瓣1例,食管金属圆环1例,胃内黄金戒指1例,金属发夹1例,食管及胃内硬币异物33例(1角、5角、1元)。1例胃内黄金戒指及1例胃内金属发夹取出时有轻微胃黏膜划伤、少许出血,余无其他并发症。结论电子胃镜治疗儿童上消化道异物安全、有效,可作为首选治疗方法。     

上消化道胃肠道间质瘤的内镜及临床分析

目的探讨上消化道胃肠道间质瘤(GIST)的内镜、病理及免疫组化特征,以提高内镜医生对该疾病的认识和诊断,减少误诊和漏诊。方法检索我院2007年1月至2010年4月所有经手术治疗的GIST,选择病变部位在食管、胃、十二指肠的病例,分析其临床表现、胃镜表现,辅助检查、手术病理及免疫组化结果。结果 30例患者中,以消化道出血为主要症状的患者11例(36.7%),腹痛的患者6例(20%),腹部不适的4例(13.3%),查体发现的3例(10%)。GIST部位:胃底12例(40%),胃体7例(23.3%)。胃镜下表现:(1)黏膜下隆起,表面光整,12例;(2)黏膜下隆起伴顶端溃疡7例;(3)溃疡型肿物4例;(4)黏膜下隆起顶端凹陷3例;(5)黏膜下隆起表面增殖糜烂1例;(6)黏膜下隆起伴糜烂2例;(7)胃镜阴性:1例。其中14例行超声内镜检查,多数病变来源于固有肌层。29例病理为梭形细胞肿瘤,免疫组化:CD117阳性29例(96.7%),CD34阳性27例(90%)。结论上消化道GIST临床表现多样,症状以消化道出血和腹痛、腹部不适为多。胃镜下表现不一,表现为黏膜隆起性病变,40%的病例黏膜表面光整,56.7%的病例呈溃疡表现或糜烂,少数病例肿物表面增殖,与胃癌不易鉴别。超声胃镜的诊断率高。     

小儿上消化道异物现状调查与影响因素分析

目的调查小儿上消化道异物现状并分析影响因素。方法采用方便抽样的方法,对武汉市儿童医院普通外科的60例消化道异物患儿进行问卷调查。结果小儿上消化道异物的发生与居住环境、看护家属、年龄、性别等因素存在一定的相关性。2~6岁患儿占85%,男女发病率1∶0.18,农村儿童占53%;应用胃镜取异物占73.3%,成功率达95.4%。结论造成小儿上消化道异物的原因包括家长知识缺乏、小儿天性好动、看护人员照顾疏忽等,医护人员对家长及看护人员要加强健康宣教,以减少或避免上消化道异物的发生。