食管薄层CT扫描诊断颈段食管异物及不同治疗方法的选择

目的 探讨食管薄层CT扫描诊断颈段食管异物作为最佳检查及确定异物部位的手段,据其采取相应不同的治疗方案,提高诊治率.方法 回顾性分析179例颈段食管异物患者的临床资料,均有明确异物史,表现为异物感、吞咽梗阻感和疼痛;术前均行影像学检查,X线或高分辨率CT扫描,确定异物部位,并根据异物所处部位采取不同的手术方式.结果 通过全身麻醉下硬质食管镜取出异物68例,表面麻醉下经胃镜取出60例,颈段食管鱼骨患者从就诊始12 h后影像学检查异物及症状消失而未做治疗29例,经颈侧切开取出异物10例,食管硬币患儿在无麻状态下应用16号Foley导尿管经口取出12例.结论 饮食过急或进食时注意力不集中是造成食管异物的主要原因,明确诊断颈段食管异物的性质、大小、位置,以及评估异物对机体损伤的程度,及时有效治疗,是治疗颈段食管异物及避免并发症的关键.

Diagnosis of foreign bodies in the cervical esophagus by CT scan and treatment options

Objective To investigate the role of CT scan as an optimal approach in the diagnosis of foreign bodies in the cervical esophagus, and to explore the different treatment options based on the scan results. Methods Clinical data of 179 patients admitted to our department due to upper esophageal foreign body during May 2011 and Oct. 2014 were retrospectively analyzed. All cases had symptoms of dysphagia, swallowing obstruction and pain. The diagnosis of upper esophageal foreign body was confirmed via X ray or HRCT examination. The foreign bodies were removed with different methods based on results of CT scan. Results The foreign bodies were removed with rigid esophagoscope under general anesthesia in 68 cases, with electronic gastroscope under topical anesthesia in 60 cases, with lateral neck incision in 10 cases, with 16# Foley catheter under no anesthesia in 12 baby patients. Another 29 patients with fishbone received no treatment because the foreign bodies and symptoms disappeared within 12 hours. Conclusion Eating too fast or being absent-minded during dinner are the major causes of esophageal foreign bodies. Correct evaluation of the nature, size, position of the foreign bodies, and damage they might do to patients, as well as timely management are key to treat cervical esophageal foreign bodies and avoid complications.