小儿上消化道异物胃镜取出术——附53例报告

目的探讨胃镜在小儿上消化道异物取出术中的价值。方法1996年6月～2005年12月，对53例小儿上消化道异物胃镜下分别用鼠齿钳、圈套器、异物网篮、活检钳、三爪钳取出。结果1例食管异物胃镜下取出失败；2例圆钝食管异物送入胃内，1d后经肠道自行排出；余50例异物胃镜下取出成功，胃镜下小儿上消化道异物取出成功率94．3％（50／53）。黏膜出血2例，并发症发生率3．8％（2／53）。结论经胃镜小儿上消化道异物取出术有效、安全，怀疑有穿孔时不宜经胃镜下异物取出。     

食管异物诊治:手术或者内镜?

目的总结食管异物治疗经验,为食管异物的诊治提供借鉴。方法回顾性分析空军军医大学附属第二医院2011年12月—2019年5月共149例食管异物患者的临床资料,其中女75例(50.3%)、男74例(49.7%),平均年龄57(2~85)岁。结果146例经胃镜确诊,3例未发现异物。127例经胃镜取出,19例经手术治疗。食管异物以食源性为主,西北地区常见异物为枣核。48 h内取出异物黏膜损伤发生率为47.54%,48 h后取出异物者并发症发生率为100.0%。异物合并穿孔取出成功率低(P=0.005),超细胃镜在难取的颈部异物和其它部位异物差异无统计学意义(P=0.157)。结论异物越尖锐,越易穿孔;异物越早取出并发症越少;异物的大小决定内镜下取出的难易程度;确诊及治疗首选软式内镜,尤其是超细胃镜,内镜无法取出的异物再行手术治疗。     

自慰性直肠异物诊治经验(附31例报告)

目的总结自慰性直肠异物的诊治经验。方法分析本院2014年1月至2015年1月期间收治的31例自慰性直肠异物临床病历资料,总结自慰性直肠异物的诊治经验。结果共收治31例自慰性直肠异物患者,其中男性30例,女性1例;年龄23～68岁,平均(55.32±11.27)岁,其中55岁及以上25例,占80.65%;灌肠导泻后均未排出异物后经肛门取出术5例,经肛门取出术共28例(90.32%),开腹取出异物术3例(9.68%)。结论自慰性直肠异物患者大多数为中老年男性,经肛门取出异物是其主要的治疗方式,及时正确的操作可提高经肛门取出异物的成功率。     

复杂食管异物的诊治(附64例报告)

目的总结复杂食管异物的诊治经验. 方法回顾性分析我院1994年1月～2004年7月64例复杂食管异物的临床资料,分析异物种类和停留部位. 结果动物骨类异物占50.0%(32/64),义齿占20.3%(13/64),枣核占14.1%(9/64),其它异物占15.6%(10/64).异物停留在第一、二、三狭窄区分别占68.7%(44/64)、26.6%(17/64)、1.6%(1/64),2例(2/64,3.1%)停留在食管癌术后吻合口上方.与50岁以下患者相比,50岁以上患者义齿类异物及第二狭窄区异物比例增高,分别为30.0%(9/30)与43.3%(13/30),差异有显著性(P<0.05);59例经内镜取出异物治愈,3例颈侧切开治愈,2例转院治疗.食管穿孔6例,4例由食管异物本身造成,2例取异物时手术所致;5例异物取出经保守治愈,1例异物未取出转院治疗. 结论详细询问病史,了解异物种类、停留部位和对周围组织损伤的程度,选择适当麻醉、内镜与操作手法,对安全取出异物以及预防并发症极为重要.     

膀胱镜钬激光碎石联合异物钳节育器取出术治疗节育器异位性膀胱结石

目的:探讨经尿道膀胱镜钬激光碎石联合异物钳节育器取出术治疗节育器异位性膀胱结石的临床疗效。方法:回顾2007年1月至2018年10月利川市人民医院运用经尿道膀胱镜钬激光碎石联合异物钳节育器取出术治疗的23例节育器异位性膀胱结石患者的临床资料,分析其临床疗效及患者满意度。结果:23例患者异位性节育器完整取出;手术时间40...     

医源性与非医源性血管内异物的取出策略与方法：附15例报告

背景与目的 近年来,随着介入技术及器械的不断进步,血管内异物（IFB）的取出技术有了一定的进展,但由于异物的类型、留置部位、大小等的不同,IFB取出的操作难度不同。因此,本文中笔者对近年来收治的医源性与非医源性IFB患者的治疗经过进行分析总结,以期为临床诊治此类疾病提供参考。方法 回顾性分析2012年1月—2021年9月中国人民解放军联勤保障部队第九〇〇医院普通外科收治的15例IFB患者资料,对异物来源,残留部位,手术过程等进行总结,并复习相关文献。结果 15例患者中医源性IFB 12例,非医源性IFB 3例;男9例,女6例;年龄21~79岁,平均为（56.67±17.63）岁;手术时间为20~110 min,平均（51±23.62）min;原发病包括外伤性3例,乳腺癌2例,胃癌2例,下肢深静脉血栓形成2例,肺癌2例,肝癌1例,宫颈癌1例,脑梗死伴颈动脉狭窄1例,肾功能不全1例。15例IFB均顺利取出,技术成功率为100%,单纯介入治疗取出异物10例,1例行腹腔镜下异物取出术,4例行传统外科手术切开取出。术前除1例因血管支架移位导致主动脉破裂大出血外,其余患者均未出现相应并发症,如血管破裂、出血、感染、继发性血栓形成等;术后给予抗凝治疗,15例患者经随访,均未出现并发症,超声复查血管通畅。结论 大多数IFB患者可通过急诊手术处理,首选治疗方式采用介入治疗方式,对于简单病例,可通过鹅颈抓捕器进行抓捕异物,而针对较难取出的患者,可通过导丝塑形或改用较大的环形圈套器,操作者术中需耐心操作;对于介入操作困难的病例,可结合临床具体情况,术中中转腹腔镜或开放手术进行治疗,安全性也较好。     

9例下消化道异物的治疗体会

我院自1978年至1985年手术、非手术治疗消化道异物148例,其中下消化道异物9例,占6%。此9例我们采用异物经腹肛门取出术治疗均获成功,现报道如下。     

上消化道异物75例诊治体会

目的对上消化道异物的诊治手段及结果进行阶段总结，方便今后诊治手段的选择。方法对1999～2006年甘肃省康泰医院收治的75例上消化道异物患者的诊断及治疗过程进行回顾性研究。结果本组病例经保守治疗异物自行排出42例，内镜取出8例，外科手术取出25例，均取得了满意的疗效，住院期间未出现严重并发症。结论上消化道异物的治疗措施，应依照异物具体情况选择，推荐内镜治疗为首选治疗方法。     

腹腔镜胆囊切除术戳孔并发症298例临床分析

我院1992年10月～2005年6月行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）9934例,发生戳孔并发症298例（3.0%）。其中戳孔感染248例,25例经扩创引流后痊愈,其余经通畅引流后痊愈;戳孔异物残留30例,20例为结石残留,9例为钛夹残留,1例为针头断裂残留,均经扩创取出异物后痊愈;戳孔疝18例,均经再次手术修补后痊愈;胃损伤1例,经胃肠减压等治疗后痊愈;腹腔大血管损伤1例,术中失血性休克死亡。     

全身麻醉下食管异物取出术126例

目的探讨全身麻醉下食管异物取出术的优越性。方法回顾我科自1998年以来126例全麻下食管异物取出术的临床资料。结果本组共行手术126例,其中122例取出异物(96.8%),3例异物推入胃内,1例转入胸科治疗(0.8%)。结论患者全身麻醉下,由于肌肉松弛,操作时间充足,故可大大提高手术成功率,减少了手术并发症。     

下消化道食源性异物14例诊治分析

目的 探讨下消化道食源性异物的诊断和治疗方法.方法 回顾性分析2017-01—2020-12苏州市吴中人民医院普外科收治的14例下消化道食源性异物患者的临床资料,总结异物类型、位置、临床表现、治疗方法及预后.结果 14例食源性异物中,枣核6例,鱼骨5例,鸡骨1例,甲鱼骨1例,鱼钩1例.出现临床症状者12例(急腹症6例、...     

Diagnostic and therapeutic endoscopy in foreign bodies of the digestive tract

The authors observed 45 patients with foreign bodies in different parts of the digestive tract. In all the patients the foreign bodies were extracted with the help of endoscopes without complications. Wide introduction of diagnostic and curative endoscopy in the clinical practice in cases with foreign bodies in the digestive tract allows to avoid operations in most cases. Besides, it considerably shortens the time of staying of such patients in the hospital.     

Lethal Intestinal Perforation After Foreign Body Ingestion in a Superobese Patient

Accidental ingestion of foreign bodies is common in the general population. Most foreign bodies pass through the entire digestive tract without incidents. However, in some cases, the ingested foreign body can cause complications such as acute abdomen due to intestinal perforation and even death. Bowel perforation may not be more common in the massively obese than in the normal-weight population but may be more problematic. We describe a super-obese female (body mass index, 52.3 kg/m²) who underwent emergency surgery for small-bowel perforation caused by an ingested foreign body (fish bone); the patient died despite segmental intestinal resection and intensive care.     

上消化道异物的外科治疗

目的 总结上消化道异物的外科治疗经验。方法 在186例上消化道异物中9例行外科治疗。并对其临床特点、手术指征、手术入路及处理技巧进行回顾性分析。结果 9例患者术后无并发症，全部治愈出院。结论 对位于食管第二狭窄或长度超过9cm的胃十二指肠异物以及经内镜取出失败者均有剖腹手术指征。手术入路应根据异物部位而选择。处理技巧适采用小切口取异物，切口缝合后，以纵隔胸膜或大网膜复盖。     

Present-day fiber endoscopy in the diagnosis and therapeutic tactics in foreign bodies of the upper digestive tract

Characterization of foreign bodies and their localization in the digestive tract in 404 patients is given. Surgical methods of treatment of such patients are described. Endoscopy was used for examination and treatment. The adequate anesthesia is thought by the authors to be necessary for a successful endoscopic removal of the foreign bodies. The indications for general anesthesia are enumerated. The endoscopic removal of the foreign bodies during surgical interventions are indicated in patients with the perforation of the esophagus by a foreign body.     

Removal of foreign bodies from the upper segment of the digestive tract using an endoscope

The work presents data of the endoscopic diagnostics and treatment of 73 patients with foreign bodies in the upper part of the digestive tract (93 objects). High efficiency and little traumatism of removals of the foreign bodies from the upper parts of the digestive tract was achieved due to using a rational tactic of curative endoscopy consisting in using different models of modern fibroendoscopes and instrumental devices.     

The diagnostics and treatment of the foreign bodies of the gastrointestinal tract

We have analyzed the results of treatment of 542 patients with the foreign bodies of the gastrointestinal tract. 359 of patients were hospitalized. All patients were somatically healthy. The majority of the foreign bodies (502 (92.6%)) were radio-opaque. 423 (78%) patients had swallowed single foreign body, the rest demonstrated multiple substunses. In 285 (52.6%) cases the foreign bodies left the organism naturally within 7 days. 230 (24%) cases required the endoscopic removal. The surgical removal of the foreign body was performed in 25 (4.6%) cases.     

Laparoscopic removal of ingested pin penetrating the gastric wall in an immunosuppressed patient

Foreign body ingestion is a well-recognized and relative common problem. Most foreign bodies pass spontaneously and uneventfully through the digestive tract. In some cases, however, the ingestion of foreign bodies is associated with a high risk of complications because of their size or shape or the hosts medical status. We report a case of successful laparoscopic removal of an accidentally ingested pin that was penetrating the anterior gastric wall in a immunosuppressed patient. After removal of the pin, the opening of the gastric wall was closed with an extracorporeal hand-suturing technique. The patient recovered uneventfully and was discharged in good health on the 5th day after the procedure. Laparoscopy should be considered the approach of choice for the removal of ingested foreign bodies when surgery is indicated.     

Urethralism concomitant with amphetamine abuse

Urethralism is a paraphilia disorder in which a person exhibits the habitual self-insertion of a foreign body into the urethra to achieve sexual gratification. We report a patient who habitually inserted a foreign body into his urethra and abused amphetamines to cope with stress. A 48-year-old man presented at the emergency room because of urine leakage from the penile base. Prior to this incident, he had been admitted to hospital 10 times from 2000 to 2005 for the removal of foreign bodies from the lower urinary tract. The patient also reported repeatedly inhaling a high dose of amphetamine to reach a “high” status prior to inserting a foreign body into his urethra. After the successful removal of the foreign bodies, the patient was referred to a psychiatrist for management in coping with stress and illicit drug withdrawal. Psychiatric support and treatment appeared to have a beneficial effect on his sexual behavior. In the management of a case involving recurrent insertion of a foreign body into the lower urinary tract, clinicians should enquire about a history of drug abuse and consult the psychiatry department regarding stress management and drug abstinence.     

Endoscopic diagnosis and removal of foreign bodies from upper segments of the digestive tract

The authors have made an analysis of urgent endoscopic examinations performed on 165 patients with foreign bodies in the upper part of the digestive tract. The occurrence and character of foreign bodies in different organs, extraction with the help of an endoscope, prevention of possible complications are considered.