Cheng Hao-Tsai, Cheng Chi-Liang, Lin Cheng-Hui, Tang Jui-Hsiang, Chu Yin-Yi, Liu Nai-Jen, Chen Pang-Chi
Division of Digestive Therapeutic Endoscopy, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan.
BMC Gastroenterol. 2008 Jul 25;8:31. doi: 10.1186/1471-230X-8-31.
The ingestion of caustic substances induces an extensive spectrum of injuries to the aerodigestive tract which include extensive necrosis and perforation of the esophagus and stomach. The gold standard of safely assessing depth, extent of injury, and appropriate therapeutic regimen is esophagogastroduodenoscopy (EGD). The objective of this study was to report our clinical experience and to evaluate the role of a 6-point EGD classification system of injury in predicting outcomes in adult patients diagnosed with caustic agent ingestion.
The study was a retrospective medical chart review from 273 patients admitted to the Chang Gung Memorial Hospital in Tao-Yuan, Taiwan between June 1999 and July 2006 for treatment of caustic ingestion. The patients underwent EGD within 24 hours of admission and mucosal damage was graded using Zagar's modified endoscopic classification scheme. After treatment, patients were followed in the outpatient clinic for a minimum of 6 months.
A total of 273 patients were included for analysis. Grade 3b injury was the most common caustic injury (n = 82, 30.03%), followed by grade 2b injuries (n = 62, 22.71%). Stricture was the most common complication (n = 66, 24.18%), followed by aspiration pneumonia (n = 31, 11.36%), and respiratory failure (n = 21, 7.69%). Compared to grade 3a mucosal injury, grade 3b mucosal injuries were at greater risk of prolonged hospital stay (odds ratio [OR]: 2.44; 95% confidence interval [CI]: 1.25-4.80), ICU admission (OR: 10.82; 95% CI: 2.05-200.39), and gastrointestinal (OR: 4.15; 95% CI: 1.55-13.29) and systemic complications (OR: 4.07; 95% CI: 1.81-14.07).
In patients with caustic ingestion, EGD should be performed within 12 to 24 hours and categorized according to a 6-point scale. Patients with grade 3b burns identified on endoscopy have high rates of morbidity. The 6-point scale is useful for predicting immediate and long-term complications, and guiding appropriate therapy.
腐蚀性物质的摄入会导致上消化道广泛损伤，包括食管和胃的广泛坏死和穿孔。安全评估损伤深度、范围及合适治疗方案的金标准是食管胃十二指肠镜检查（EGD）。本研究的目的是报告我们的临床经验，并评估一种6分EGD损伤分类系统在预测诊断为腐蚀性物质摄入的成年患者预后中的作用。
本研究是一项回顾性病历审查，研究对象为1999年6月至2006年7月间因腐蚀性物质摄入而入住台湾桃园长庚纪念医院的273例患者。患者在入院24小时内接受了EGD检查，并使用扎加尔改良的内镜分类方案对黏膜损伤进行分级。治疗后，患者在门诊至少随访6个月。
共有273例患者纳入分析。3b级损伤是最常见的腐蚀性损伤（n = 82，30.03%），其次是2b级损伤（n = 62，22.71%）。狭窄是最常见的并发症（n = 66，24.18%），其次是吸入性肺炎（n = 31，11.36%）和呼吸衰竭（n = 21，7.69%）。与3a级黏膜损伤相比，3b级黏膜损伤患者住院时间延长的风险更高（比值比[OR]：2.44；95%置信区间[CI]：1.25 - 4.80）、入住重症监护病房的风险更高（OR：10.82；95% CI：2.05 - 200.39），发生胃肠道（OR：4.15；95% CI：1.55 - 13.29）和全身并发症的风险更高（OR：4.07；95% CI：1.81 - 14.07）。
对于腐蚀性物质摄入的患者，应在12至24小时内进行EGD检查，并根据6分制进行分类。内镜检查发现为3b级烧伤的患者发病率较高。6分制有助于预测近期和远期并发症，并指导适当的治疗。
