Waltzman Mark L, Baskin Marc, Wypij David, Mooney David, Jones Dwight, Fleisher Gary
Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
Pediatrics. 2005 Sep;116(3):614-9. doi: 10.1542/peds.2004-2555.
Children frequently ingest coins. When lodged in the esophagus, the coin may cause complications and must either be removed or observed to pass spontaneously.
(1) To compare relatively immediate endoscopic removal to a period of observation followed by removal when necessary and (2) to evaluate the relationship between select clinical features and spontaneous passage.
DESIGN/SETTING: Randomized, prospective study of children <21 years old who presented to an emergency department with esophageal coins in the esophagus. Exclusion criteria were (1) history of tracheal or esophageal surgery, (2) showing symptoms, or (3) swallowing the coin >24 hours earlier. Children were randomized to either endoscopic removal (surgery) or admission for observation, with repeat radiographs approximately 16 hours after the initial image.
Proportion of patients requiring endoscopic removal, length of hospital stay, and the number of complications observed.
Among 168 children who presented with esophageal coins lodged in the esophagus, 81 were eligible. Of those eligible, 60 enrolled, 20 refused consent, and 1 was not approached. In the observation group, 23 of 30 (77%) children required endoscopy compared with 21 of 30 (70%) in the surgical group. Total hospital length of stay was longer in the randomized-to-observation group compared with the randomized-to-surgery group (mean: 19.4 [SD: +/-8.0] hours vs 10.7 [SD: +/-7.1] hours, respectively). There were no complications in either group. Spontaneous passage occurred at similar rates in both groups (23% vs 30%). Spontaneous passage was more likely in older patients (66 vs 46 months) and male patients (odds ratio: 3.7; 95% confidence interval: 0.98-13.99) and more likely to occur when the coin was in the distal one third of the esophagus (56% vs 27% [95% confidence interval: 1.07-5.57]).
Because 25% to 30% of esophageal coins in children will pass spontaneously without complications, treatment of these patients may reasonably include a period of observation, in the range of 8 to 16 hours, particularly among older children and those with distally located coins.
儿童经常吞食硬币。当硬币卡在食管时，可能会引发并发症，必须将其取出或观察其是否能自行排出。
（1）比较相对立即进行内镜取出与先观察一段时间后必要时再取出的情况；（2）评估特定临床特征与硬币自行排出之间的关系。
设计/地点：对21岁以下因食管内有硬币而到急诊科就诊的儿童进行随机、前瞻性研究。排除标准为：（1）有气管或食管手术史；（2）出现症状；（3）在24小时前吞食硬币。儿童被随机分为内镜取出组（手术组）或入院观察组，在初始影像后约16小时重复进行X光检查。
需要内镜取出的患者比例、住院时间以及观察到的并发症数量。
在168例食管内有硬币的儿童中，81例符合条件。在符合条件的儿童中，60例登记参加，20例拒绝同意，1例未被纳入。观察组中，30例儿童中有23例（77%）需要内镜检查，而手术组中30例儿童中有21例（约70%）需要内镜检查。随机分组到观察组的儿童总住院时间比随机分组到手术组的儿童长（平均：分别为19.4[标准差：±8.0]小时和10.7[标准差：±7.1]小时）。两组均未出现并发症。两组硬币自行排出的发生率相似（23%对30%）。年龄较大的患者（66个月对46个月）和男性患者（优势比：3.7；95%置信区间：0.98 - 13.99）更有可能出现硬币自行排出的情况，当硬币位于食管远端三分之一时也更有可能自行排出（56%对27%[95%置信区间：1.07 - 5.57]）。
由于25%至30%的儿童食管内硬币会自行排出且无并发症，对这些患者的治疗可以合理地包括一段8至16小时的观察期，尤其是年龄较大的儿童和硬币位于远端的儿童。
