Majola N F, Kong V Y, Mangray H, Govindasamy V, Laing G L, Clarke D L
Department of Paediatric Surgery, Grey's Hospital, Pietermaritzburg, South Africa.
S Afr Med J. 2018 Feb 27;108(3):205-209. doi: 10.7196/SAMJ.2018.v108i3.12590.
The ingestion or aspiration of foreign bodies (FBs) by children is a common problem around the world. Our centre in Pietermaritzburg, South Africa, has a dedicated paediatric surgical service, and all patients with an ingested or aspirated FB are managed under the direct care of a paediatric surgeon.
To review our centre's experience with this problem by means of a retrospective audit and use the data to develop and refine appropriate local management guidelines.
Grey's Hospital has a hybrid electronic medical registry (HEMR) that captures patient data on admission, after a procedure and on discharge. The HEMR was reviewed and all patients with an appropriate International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code indicating an ingested or aspirated FB were identified and retrieved for review.
A total of 105 cases of FB ingestion or aspiration in children <12 years of age from January 2012 to December 2014 were identified from the HEMR. The patients' ages ranged from 4 months to 10 years (mean 3 years and 6 months), and 59.0% (n=62) were male and 41.0% (n=43) female. A total of 107 FBs were removed (two patients each had two coins removed). The commonest FBs were coins (n=77, 71.9%), followed by batteries (n=6, 5.6%), plastic toys (n=5, 4.7%), buttons (n=5, 4.7%), screws/washers (n=3, 2.8%), seeds (n=2, 1.9%), needles (n=2, 1.9%), bones (n=2, 1.9%), a marble (n=1, 0.9%), a rubber eraser (n=1, 0.9%), a curtain hook (n=1, 0.9%), a nail (n=1, 0.9%) and a wood speck (n=1, 0.9%). Of the FBs, 67 (62.6%) were in the oesophagus, 17 (15.9%) in the respiratory system, 14 (13%) in the intestine and 9 (8.4%) in the oral cavity. The average time from ingestion/aspiration to presentation was <48 hours. Of the FBs, 67 (62.6%) were removed via rigid oesophagoscopy and 13 (12.1%) via rigid bronchoscopy, 13 (12.1%) were passed rectally, and 9 (8.4%) were removed via grasping forceps in the oral cavity, 4 (3.7%) via thoracotomy and 1 (0.9%) via emergency laparotomy. A total of 15 complications included mucosal ulceration/slough (n=6, 40.0%), oesophageal perforation (n=3, 20.0%), aspiration pneumonia (n=3, 20.0%), and tracheal perforation, lung collapse and contact bleed (n=1 each, 6.7%). No patient presented in respiratory distress or needed emergency airway management, and there were no deaths.
The development of a dedicated paediatric surgery service and the implementation of management protocols have resulted in excellent outcomes for this problem.
儿童摄入或误吸异物在全球都是一个常见问题。我们位于南非彼得马里茨堡的中心设有专门的儿科手术服务，所有摄入或误吸异物的患者均由儿科外科医生直接护理。
通过回顾性审计来总结我们中心处理该问题的经验，并利用这些数据制定和完善适当的本地管理指南。
格雷医院有一个混合电子病历登记系统（HEMR），可在患者入院时、手术后及出院时记录患者数据。对HEMR进行了审查，确定并检索了所有具有适当的国际疾病及相关健康问题统计分类第十次修订版（ICD - 10）编码表明摄入或误吸异物的患者，以供审查。
从HEMR中确定了2012年1月至2014年12月期间105例12岁以下儿童摄入或误吸异物的病例。患者年龄从4个月至10岁（平均3岁6个月），男性占59.0%（n = 62），女性占41.0%（n = 43）。共取出107个异物（两名患者每人取出两枚硬币）。最常见的异物是硬币（n = 77，71.9%），其次是电池（n = 6，5.6%）、塑料玩具（n = 5，4.7%）、纽扣（n = 5，4.7%）、螺丝/垫圈（n = 3，2.8%）、种子（n = 2，1.9%）、针（n = 2，1.9%）、骨头（n = 2，1.9%）、弹珠（n = 1，0.9%）、橡皮（n = 1，0.9%）、窗帘钩（n = 1，0.9%）、钉子（n = 1，0.9%）和木屑（n = 1，0.9%）。在这些异物中，67个（62.6%）位于食管，17个（15.9%）位于呼吸系统，14个（13%）位于肠道，9个（8.4%）位于口腔。从摄入/误吸到就诊的平均时间小于48小时。在这些异物中，67个（62.6%）通过硬式食管镜取出，13个（12.1%）通过硬式支气管镜取出，13个（12.1%）经直肠排出，9个（8.4%）通过口腔用镊子取出，4个（3.7%）通过开胸手术取出，1个（0.9%）通过急诊剖腹手术取出。共有15例并发症，包括黏膜溃疡/脱落（n = 6，40.0%）、食管穿孔（n = 3，20.0%）、吸入性肺炎（n = 3，20.0%）以及气管穿孔、肺萎陷和接触性出血（各1例，6.7%）。没有患者出现呼吸窘迫或需要紧急气道处理，也没有死亡病例。
专门的儿科手术服务的发展以及管理方案的实施，使得该问题取得了良好的治疗效果。
