经纤维胃镜取出食管内刀片方法的初步实践

目的：为了在运用胃镜从食管中取出刀片之手术中，探讨有效的操作方法，以提高胃镜取异物的成功率。方法：观察6例从食管中取出单刃刀片及金属异物的技术操作过程。结果：3例单刃刀片取出术和1例铝片取出术获得成功，2例失败。结论：选用鳄嘴状异物钳作为手术器械是最有效的手段，因力可防止刀片滑脱；选用安全保护套管可以防止食管损伤。刀片体积相对过大、食管生理狭窄发生痉挛水肿时不宜施行此类手术。     

9例特殊食管异物临床分析

目的：探讨几种特殊食管异物的诊治方法，提高其诊治水平。方法：对9例特殊食管异物的临床资料进行回顾性分析。结果：有8例异物经食管镜取出，1例经颈侧切开取出。食管损伤5例，食管穿孔2例，全部治愈。结论：特殊食管异物的处理应准备充分，采用最佳取出方法，防止并发症的发生。     

食管异物(义齿)取出3例报告

例 1 ,女 ,42岁 ,30ｍｉｎ前 ,患者早饭时突觉有异物咽下 ,并感胸前堵塞 ,吞咽困难。间接喉镜检查 :右梨状窝积液 ,喉部未发现异物。Ｘ线透视提示食管上段异物 (义齿 )。入院后在表麻下行食管镜试取异物。当食管镜进入距门齿 1 5ｃｍ ,发现白色义齿及一根金属丝环 ,吸净义齿表面分泌物 ,以鳄鱼钳夹紧义齿金属钩环向外拉取 ,阻力较大 ,向下推送亦不移动 ,后加力向外拉取 ,异物近端有少量出血 ,故停止试取 ,再以单齿旋转钳牢牢夹住义齿中间处进行上、下推拉 ,左右移动 ,当义齿稍有松动后 ,用力将义齿连同食管镜一起拉出 ,患者顿觉咽痛难忍 ,口…     

年少儿童食管异物诊治经验总结

目的：食管内异物为消化内科常见病，多见于儿童，尤其是年少儿童。废文总结了部分年少儿童食管异物诊断及处理经验。方法：该院1996～2004年确诊的年少儿童上消化道异物病例共52例，其中食管异物均行电子胃镜下异物取出术。结果：食管内异物共33例．约占63％。其中硬币共25例，约占76％。26例镜下见异物停滞于食管入口处。3例停滞于食管中段，4例停滞于食管下段。1例尖锐物体合并咽喉部脓肿（1．92％），成功取出食管异物23例，推入胃内6例，4例自动排出体外。结论：内镜下食管异物取出为安全有效方法，尖锐异物应尽早取出以减少并发症。     

老年人食管异物取出术采用全麻与表面麻醉的比较

目的探讨老年人食管异物取出术麻醉方法选择，以提高手术效果。方法对1986年至2003年采用表面麻醉或全麻食管镜下取老年人食管异物81例临床资料回顾分析。结果对危险异物，全麻组食管损伤小于表面麻醉组（P＜0．01）；表面麻醉组2例食管镜下取异物失败。结论老年人食管镜下取异物，术前需全面分析，针对危险异物应采用全麻，以减少潜在危险性。     

食管异物的早期外科处理

食管异物在日常生活中极为常见，绝大多数患者可经食管镜或纤维胃镜取出异物；然而部分患者不能取出或强行取出后，有可能导致食管穿孔、主动脉损伤甚至死亡。本科自1987年5月至2005年5月对12例经食管镜及胃镜处理后，不能取出及取出异物后出现并发症的食管异物患者需外科处理的诊治体会报道如下。     

58例食管中段异物的诊断和处理评价

目的：评价食管中段异物的诊断及内镜下治疗措施。方法：在内镜直视下根据不同类型的异物应用不同的器械将异物取出。结果：58例食管中段异物，内镜下取出53例，成功率91．40％，除1例发生纵隔气肿外，均无其它并发症发生。未能取出异物的5例，均系病程超过48h，有穿孔并发症迹象，其中鱼刺4例，义齿1例。经外科治疗后死亡2例。结论：内镜下食管中段异物取出术是一种安全、有效的治疗方法。     

颈胸段食管嵌顿性巨大异物并穿孔1例

1病例报告 男，45岁。因误吞义齿1d急转我院。自诉颈部、胸骨后疼痛，梗阻感，吞咽困难。外院2次行食管镜手术失败。查体：神志清楚，痛苦面容，体位自动，颈部压痛明显。咽部黏膜光滑，间接喉镜：会厌，双侧梨状窝结构对称，黏膜无充血、水肿。喉内未见异常。食道吞钡示：胸段食管上段见呈冠状位蝶形金属异物影，两端钢丝已凸出腔外约0．9cm，呈水平位。人院诊断：颈胸段食管异物并穿孔（义齿）。术前急诊常规辅检无异常，考虑异物大，且穿过食管壁，取出有困难，请胸外科会诊后，备血400ml，先行全麻下食道镜检加异物取出术。全麻后术中用30cm硬管食管镜插入17cm左右时见食管壁充血、肿胀、有钡棉、分泌物多，清除后见义齿冠状位嵌顿于食管内，拨动时见上端两根钢丝穿过食管壁，钳夹义齿将左上方钢丝退到食道内，约1cm长，则右上方钢丝不能退出食管壁，反复几次均不能使义齿钩松脱，无法取出义齿，退镜。     

气囊导尿管在小儿食管异物取出术中的应用观察

小儿由于年龄的特点,喜欢把各类物品放入口中,很容易误咽使部分物品嵌顿于食管,造成食管异物,尤其以金属硬币多见。对于食管异物的取出,传统方法是采用硬直食管镜法直接钳取或电子胃镜活检钳钳取。2008～2010年我院应用无菌乳胶导尿管（简称For1ey管,亦称气囊导尿管）成功取出12例小儿食管异物（硬币和纽扣），现报告如下。 1 临床资料     

罕见食管异物2例

食管异物虽是临床常见病，但复杂的金属异物可造成食管损伤及穿孔。我院曾遇较复杂的特殊病例2例，现报告如下。1病例介绍[例1]男性，74岁，因误咽义齿于1993年2月3日来诊，患者曾因脑血管意外而留有偏瘫，痴呆，语言不清等后遗症。本人及家属不能正确回顾病史。胸片发现在颈3、胸4椎体水平处各有金属钩影像。下一个影像恰在主动脉弓下1厘米处。因患者一般情况较差，我们决定在表面麻醉下用食管镜试取异物。下入食管镜，在食管入口处可见异物，用钳松动后觉无牵挂，顺利取出一长4．6厘米、宽3厘米的义齿，继续下入食管镜，在距门齿23至25厘…     

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.     

Management of gastric metallic foreign bodies in children

QuestionA 2-year-old boy presented to my clinic after a caregiver witnessed him swallow a foreign body. The caregiver recalls seeing a small metallic object but is unsure exactly what was ingested. The child was asymptomatic upon examination. How should I identify and localize the foreign body? Do metal foreign bodies need to be removed endoscopically?AnswerForeign body ingestion is very common in children. Considerations must be made for the type of foreign body and site of impaction. A clear patient history and radiographs should be used to localize and identify the object. Handheld metal detectors can also be used to localize known metallic foreign bodies. Most metallic objects that pass the esophagus and reach the stomach will continue to pass without complication. Bowel perforation, sepsis, and even death have been documented in extremely rare cases of multiple magnets, button batteries, and long, angular, or 2-pointed sharp objects. These objects must be removed. Other metallic foreign bodies including coins and single magnets can be managed conservatively with stool monitoring.     

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.     

471例食管异物内镜下取出术的分析及术中护理配合

目的对471例食管异物患者进行内镜异物取出术,按食管3个生理狭窄进行分段治疗,总结术中护理配合要点。方法根据异物不同形态、性质、大小,在内镜下选用不同器械将异物取出。结果 471例患者中431例在门诊顺利取出,其中15例异物取出后收住院观察,8例住院后再行异物取出术。431例异物取出的患者均无并发症发生。6例因异物嵌顿于主动脉弓段,且嵌顿处黏膜损伤明显,转入胸外科手术治疗,11例因食管上段异物内镜下无法取出,转入五官科就诊。结论完善食管异物的诊疗流程,按程序进行诊断治疗至关重要。食管异物取出术应充分重视术前的评估,根据评估结果选择合适的器械,合适的方法,及时准确熟练配合,可及时解除患者的痛苦,有效防止并发症的发生。     

老年人食管异物65例临床分析

目的:探讨老年人食管异物的临床特点及治疗方法.方法:回顾性分析我科2000年1月至2010年12月收治的老年人食管异物患者65例的临床资料.结果:所有患者经食管镜检查,取出异物57例;推入胃内6例;1例经开胸取出;2例并发颈部脓肿,其中1例因大量出血转外院治疗.结论:尽早发现老年人食管异物并选择合适的麻醉及治疗方式可避免各种严重并发症的发生.     

成人气管和支气管异物的诊治

目的 探讨成人气管支气管异物的临床特点以及诊治.方法 回顾性分析我院1996年1月至2010年1月收治的24例成人气管支气管异物的病例资料,其中男16例,女8例,年龄18~85岁.结果 成人气管支气管异物种类多样,临床表现各异,容易漏诊,其中有1例漏诊长达7年之久.24例中,有10例行硬质支气管镜下取出异物;7例纤维支气管镜下取出异物;3例患者入院后自行咳出异物;1例在支撑喉镜下取出异物;1例急诊行气管切开异物取出术;共治愈22例,死亡2例.结论 成人气管支气管异物少见,临床表现各异,容易误诊.绝大多数成人气管和支气管异物可通过纤维支气管镜或硬性气管镜处理而痊愈.     

Clinical study in 11 cases of endobronchial foreign body

We report 11 cases of endobronchial foreign body. From January 1982 through December 1994, a total of 11 cases were diagnosed roentogenographically and bronchoscopically at our hospital. These patients consisted of 10 men and 1 woman with a mean age of 58.5 years (range 33 to 77 years). Symptoms on presenting were usually cough, sputum, or chest pain. The foreign bodies were inorganic in 10 cases and of organic origin in 1 case. Three patients were not aware that they had aspirated a foreign body. In 9 patients, the endobronchial foreign bodies were successfully removed endoscopically. One patient spontaneously expectorated the foreign body before bronchoscopy. One patient underwent thoracotomy because the foreign body could not be removed bronchoscopically. There were no severe complications during or after the endoscopic removal of the foreign bodies, but in one patient extraction of the foreign body caused pneumonia after bronchoscopy. In conclusion, flexible bronchoscopy is useful for the diagnosis and treatment of endobronchial foreign bodies.