小儿急诊科食管硬币异物探条扩张术的临床疗效

Clinical effectiveness of bougienage for esophageal coins in a pediatric ED.

作者信息

Allie Evan H, Blackshaw Aaron M, Losek Joseph D, Tuuri Rachel E

机构信息

Medical University of South Carolina Children's Hospital, Department of Pediatrics Residency Program, Charleston, SC.

Medical University of South Carolina, College of Medicine, Charleston, SC.

出版信息

Am J Emerg Med. 2014 Oct;32(10):1263-9. doi: 10.1016/j.ajem.2014.08.007. Epub 2014 Aug 7.

DOI:10.1016/j.ajem.2014.08.007

PMID:25178851

Abstract

OBJECTIVE

To describe a tertiary care pediatric emergency department (PED) experience with bougienage for esophageal coins.

METHODS

This was a large retrospective case series of children with esophageal coins presenting to a tertiary PED from January 2004 to October 2012. Bougienage eligibility criteria were medically stable, no prior gastro-esophageal surgery or disease, single coin, and witnessed ingestion within 24 hours. Abstracted data were age, signs and symptoms, coin type, management, efficacy, complications, returns, length of stay (LOS), and hospital charges. Main outcomes included procedural success and complications. Secondary outcomes included LOS and hospital charges.

RESULTS

There were 245 patients with esophageal coins with 136/145 (94%) successful bougienage procedures and 109/109 (100%) successful surgical retrievals. There were 18 minor complications and 5 return visits for patients with bougienage. There were 10 minor and 2 major complications with surgical retrieval. Patients undergoing bougienage were 4 years (SD 2) vs 3 years (SD 3) for surgical retrieval (P < 0.001). Mean LOS for successful bougienage was 137 minutes (SD 54) vs 769 (SD 535) for surgical retrieval. The difference in the means was 632, 95% CI for the difference in means of -723 to -541 (P < .001). Mean charges for successful bougienage were $984 (SD $576) vs. $7022 (SD $3132) for surgical retrieval. The difference in means was $6038, 95% CI -$6,580 to -$5,496 (P < .001).

CONCLUSIONS

Esophageal bougienage is safe and highly effective. It is also more time and cost efficient than other treatment options.

摘要

目的

描述三级医疗儿科急诊科采用探条扩张术治疗食管硬币异物的经验。

方法

这是一项大型回顾性病例系列研究，纳入了2004年1月至2012年10月在一家三级儿科急诊科就诊的食管硬币异物患儿。探条扩张术的入选标准为病情稳定、既往无胃食管手术或疾病史、单个硬币异物且在24小时内目睹吞食。提取的数据包括年龄、体征和症状、硬币类型、治疗方法、疗效、并发症、复诊情况、住院时间（LOS）和住院费用。主要结局包括操作成功和并发症。次要结局包括住院时间和住院费用。

结果

共有245例食管硬币异物患儿，其中136/145例（94%）探条扩张术操作成功，109/109例（100%）手术取出成功。探条扩张术患儿有18例轻微并发症，5例复诊。手术取出有10例轻微并发症和2例严重并发症。接受探条扩张术的患儿年龄为（标准差2）4岁，手术取出的患儿年龄为（标准差3）3岁（P<0.001）。成功探条扩张术的平均住院时间为137分钟（标准差54），手术取出为769分钟（标准差535）。均值差异为632，均值差异的95%置信区间为-723至-541（P<0.001）。成功探条扩张术的平均费用为984美元（标准差576美元），手术取出为7022美元（标准差3132美元）。均值差异为6038美元，95%置信区间为-6580至-5496美元（P<0.001）。