一切都会过去：一项关于摄入尖锐异物的研究。

This too shall pass: A study of ingested sharp foreign bodies.

作者信息

Zamary Kirellos R, Davis James W, Ament Emily E, Dirks Rachel C, Garry John E

机构信息

From the Department of Surgery (K.R.Z., J.W.D., E.E.A., R.C.D., J.E.G.) UCSF Fresno, Fresno, CA 93721.

出版信息

J Trauma Acute Care Surg. 2017 Jan;82(1):150-155. doi: 10.1097/TA.0000000000001265.

DOI:10.1097/TA.0000000000001265

PMID:27805997

Abstract

BACKGROUND

Gastrointestinal foreign body (GFB) ingestion is a common problem and often results in surgical consultation. Current literature is limited to case reports and fails to provide data regarding the management of sharp GFB ingestion. We hypothesized that patients who ingest sharp objects rarely have perforation or obstruction requiring surgical intervention.

METHODS

Patients presenting with GFBs from January 2005 to December 2015 at a level 1 trauma center with an acute care surgery program were retrospectively reviewed. Exclusion criteria were leaving without being seen, noningested GFB, unknown or blunt GFB, or if the GFB was not found on imaging. Data collected included patient demographics, length of stay, imaging, and interventions that were performed.

RESULTS

During the study period, there were 1,164 patients with 1,245 hospital visits for GFBs; 995 visits were excluded, resulting in 169 sharp GFB ingestion patients with 192 visits included in our study. The average age was 31. Sixty-five percent were men, and 41% were incarcerated. The average length of stay was 3 days, which was longer in patients with psychiatric holds and consultations. Of the 169 patients, 116 (69%) had no intervention and did not return for complications. Fifty-five endoscopies were performed with GFB removal in 30 cases. Seven patients (4%) underwent surgery, five of which had peritonitis. When evaluating the total study cohort, 134 (79%) of the patients had no procedure or a negative procedure. Patients requiring surgery had significantly larger objects (6 ± 3 cm) than those who had endoscopy (3 ± 2 cm) or no procedure (2 ± 1 cm).

CONCLUSION

Surgical intervention occurred in only seven (4%) patients with sharp GFB ingestions, and 79% of the patients required no intervention. Barring an acute abdomen or esophageal sharp GFBs, patients can be discharged with return precautions, admitted for necessary psychiatric care, or returned to custody for patients seeking secondary gain. Upper gastrointestinal larger GFBs should be removed endoscopically when possible.

LEVEL OF EVIDENCE

Therapeutic/care management study, level V.

摘要

背景

胃肠道异物（GFB）摄入是一个常见问题，常需要外科会诊。目前的文献仅限于病例报告，未能提供关于尖锐GFB摄入管理的数据。我们推测，摄入尖锐物体的患者很少发生需要手术干预的穿孔或梗阻。

方法

回顾性分析2005年1月至2015年12月在一家设有急性护理手术项目的一级创伤中心出现GFB的患者。排除标准为未就诊即离开、未摄入GFB、不明或钝性GFB，或影像学检查未发现GFB。收集的数据包括患者人口统计学资料、住院时间、影像学检查和所采取的干预措施。

结果

在研究期间，有1164例患者因GFB进行了1245次医院就诊；排除995次就诊，最终169例尖锐GFB摄入患者的192次就诊纳入我们的研究。平均年龄为31岁。65%为男性，41%为被监禁者。平均住院时间为3天，有精神科约束和会诊的患者住院时间更长。169例患者中，116例（69%）未进行干预且未因并发症复诊。进行了55次内镜检查，30例成功取出GFB。7例患者（4%）接受了手术，其中5例患有腹膜炎。评估整个研究队列时，134例（79%）患者未进行任何操作或操作结果为阴性。需要手术的患者所摄入物体明显大于接受内镜检查的患者（6±3cm）或未进行任何操作的患者（2±1cm）。