Zhou L Q, Zhao H, Peng K R, Tang L J, Luo Y Y, Yu J D, Lou J G, Li F B, Fang Y H, Chen F B, Chen J
Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
Zhonghua Er Ke Za Zhi. 2018 Jul 2;56(7):495-499. doi: 10.3760/cma.j.issn.0578-1310.2018.07.005.
To explore the clinical features and complications of foreign bodies in the upper gastrointestinal tract in children and to investigate the effectiveness of endoscopic management. Data of patients with foreign bodies in upper gastrointestinal tract were collected retrospectively at Endoscopy Center, the Children's Hospital, Zhejiang University School of Medicine, from January 2011 to December 2016. Clinical characteristics, the types of foreign bodies, the location and duration of foreign body impaction were summarized. The risk factors of complications and endoscopic removal failure were analyzed by using Logistic regression analysis. A total of 1 334 patients (825 males and 509 females) were enrolled. The median age was 2.5 years, with a range from 0.25 to 15 years and peak age 1-3 years. Twenty patients had esophageal diseases. The most common foreign body ingested was coin (964, 72.3%). Foreign bodies were most commonly located in the esophagus (1 002, 75.1%), especially in the upper esophagus (857, 85.5%). The duration of foreign body impaction ranged from 3 hours to 5 years. Among 1 334 patients, 252 patients (18.9%) developed complications, including ulcers (101, 40.0%) and perforations(13, 5.2%). The success rate of endoscopic removal was 96.6% (1 288). By Logistic regression analysis, sharp foreign body ingestion (=6.893, 95% 4.421-10.746) , esophageal impaction (=5.253, 95%3.352-8.233) and foreign body impaction longer than 24 hours (=4.336, 95%3.091-6.082) were risk factors of complications. Sharp foreign body ingestion was the risk factor of endoscopic failure (5.372, 95%2.773-10.406) . Coin is the most common foreign body in upper gastrointestinal tract. Sharp foreign bodies impacted in the esophagus over 24 hours increase the risk of complications. Endoscopic removal of foreign bodies from the upper gastrointestinal tract in children has a high success rate. Sharp foreign body ingestion increases the risk of failure in endoscopic removing.
探讨儿童上消化道异物的临床特征及并发症,并研究内镜治疗的有效性。回顾性收集2011年1月至2016年12月浙江大学医学院附属儿童医院内镜中心收治的上消化道异物患儿资料。总结其临床特征、异物类型、异物嵌顿部位及时间。采用Logistic回归分析并发症及内镜取出失败的危险因素。共纳入1334例患儿(男825例,女509例)。中位年龄2.5岁,年龄范围0.25至15岁,高峰年龄为1至3岁。20例患儿有食管疾病。最常见的误吞异物为硬币(964例,72.3%)。异物最常嵌顿于食管(1002例,75.1%),尤其是食管上段(857例,85.5%)。异物嵌顿时间为3小时至5年。1334例患儿中,252例(18.9%)出现并发症,包括溃疡(101例,40.0%)和穿孔(13例,5.2%)。内镜取出成功率为96.6%(1288例)。经Logistic回归分析,误吞尖锐异物(=6.893,95% 4.421 - 10.746)、食管嵌顿(=5.253,95% 3.352 - 8.233)及异物嵌顿超过24小时(=4.336,95% 3.091 - 6.082)是并发症的危险因素。误吞尖锐异物是内镜取出失败的危险因素(5.372,95% 2.773 - 10.406)。硬币是上消化道最常见的异物。尖锐异物在食管嵌顿超过24小时会增加并发症风险。儿童上消化道异物内镜取出成功率高。误吞尖锐异物会增加内镜取出失败的风险。