结直肠异物病例的临床特点及内镜诊治

目的探讨结直肠异物病例的临床特点和内镜诊治方法。方法回顾分析自2005年6月至2018年9月在北京协和医院消化内镜中心收治的结直肠异物病例,总结病例特点及处理经验。结果纳入结直肠异物病例14例,其中男性10例(71%),平均年龄49岁(21~80岁)。异物来源包括医源性5例,口源性3例,肛源性5例,不明原因1例;口源性异物和医源性异物分布于全结肠,而肛源性异物分布以乙状结肠-直肠为主。异物相关并发症共6例,包括黏膜损伤、嵌入肠壁、肠梗阻和肝脓肿。尝试内镜下取出异物共12例,11例成功,1例失败;使用的器械包括异物钳和圈套器;异物取出失败病例的主要原因是巨大异物嵌顿。结论结直肠异物的分布与其来源相关,其可能导致结肠黏膜损伤、肠梗阻或肠穿孔,并引发严重的腹腔感染;尝试于内镜下取出结直肠异物时,可选择异物钳或圈套器,异物取出后需警惕结肠穿孔可能。

Clinical characteristics and endoscopic diagnosis and treatment of colorectal foreign body cases

Objective To investigate the clinical features,endoscope diagnosis,and treatment of cases of colorectal foreign bodies.Methods A retrospective analysis of colorectal foreign body cases admitted to the Digestive Endoscope Center from June 2005 to September 2018 were completed.The information of gender,age,source and location of foreign bodies,complications,and methods of removal was collected so that characteristics and management experience were summarized.Results A total of 14 cases of colorectal foreign bodies were included,among which there were 10 males(71%)with an average age of 49 years old(21-80 years old).The origin of foreign body included iatrogenic(5 cases),oral(3 cases),anal(5 cases)and one case of unknown reason.As to the position of foreign bodies,iatrogenic and oral foreign bodies might distribute in the whole colon,while anal foreign bodies located in sigmoid-rectum mainly.In total 6 cases suffered from foreign body-related complications,including mucosal injury(1 case),intestinal wall injury(2 cases),intestinal obstruction(2 cases)and liver abscess(1 case).We attempted to remove foreign bodies under endoscopy in 12 cases,with success in 11 cases;the instruments used were foreign body forceps(7 cases)and snares(5 cases).The main reason of failure was big size of foreign bodies.Conclusions The distribution of colorectal foreign bodies is related to its origin;colorectal foreign bodies may cause colonic mucosal injury,intestinal obstruction or intestinal perforation,and even severe peritoneal infection;when attempting to remove colorectal foreign body under endoscope,foreign body forceps and snares can be used.After the foreign body's removal,it is necessary to be alert of the colon perforation.