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[83例小儿食管纽扣电池误吞的临床特征及严重并发症]

[Clinical characteristics and serious complications of esophageal button battery ingestion in the pediatric on 83 cases].

作者信息

Zhang F Z, Duan Q C, Wang G X, Yang X J, Zhang W, Zhao J, Wang H, Li H B, Ni X, Zhang J

机构信息

Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing Key Laboratory for Pediatric Diseases of Otorhinolaryngology Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing 100045, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 May 7;58(5):481-485. doi: 10.3760/cma.j.cn115330-20221026-00632.

Abstract

To analyze the clinical characteristics and complications of esophageal foreign bodies of button battery ingestion in children. A retrospective descriptive study included 83 children who were hospitalized in our hospital on account of button battery ingestion from January 2011 to December 2021. There were 50 males (60.2%) and 33 females (39.8%). The age ranged from 7.6 months to one month off 10 years, with a median age of 18 months. The data of patient demographics and time from ingestion to admission, location, symptoms, management, complications, and follow-up outcome were recorded. SPSS17.0 software was used for statistical analysis. Seventy-two children (86.7%) were younger than 3 years old. The time from ingestion to admission ranged from 1 h to 2 months, with a median time of 8 h. Among the 63 children who were first diagnosed in our hospital, the most common clinical symptoms were nausea and vomiting (32 cases, 50.8%), dysphagia (31 cases, 49.2%), salivation (11 cases, 17.5%) and fever (10 cases, 15.9%). Seventy-three of 83 cases had complete preoperative diagnostic tests, and 55 cases (75.3%) were diagnosed by X-ray. In 56 cases (76.7%), the foreign badies were impacted in the upper third of esophagus. In 72 cases (86.7%), the foreign badies were removed by rigid esophagoscopy. 23 (27.7%) had serious complications, including tracheoesophageal fistula in 15 cases(TEF;65.2%), vocal cord paralysis (VCP;34.8%) in 8 cases, esophageal perforation in 3 cases (EP;13.0%), hemorrhage in 3 cases(13.0%), mediastinitis in 3 cases (13%), and periesophageal abscess in 1 case (4.3%). There were significant differences in the exposure time of foreign bodies and unwitnessed ingestion by guardians in the complications group (<0.05). 2 cases died (2.4%)respectively due to arterial esophageal fistula bleeding and respiratory failure caused by stent displacement during the treatment of tracheoesophageal fistula. Accidental button battery ingestion can be life-threatening. and it mostly happens in children under 3 years old. Serious complications may happen cause of non-specific clinical manifestations and unwitnessed ingestions. Anterior and lateral chest X-ray is the first examination choice. Tracheoesophageal fistula is the most common serious complication.

摘要

分析儿童误吞纽扣电池所致食管异物的临床特征及并发症。一项回顾性描述性研究纳入了2011年1月至2021年12月因误吞纽扣电池而在我院住院的83例儿童。其中男性50例(60.2%),女性33例(39.8%)。年龄范围为7.6个月至差1个月满10岁,中位年龄为18个月。记录患者的人口统计学数据、从误吞到入院的时间、异物位置、症状、治疗方法、并发症及随访结果。采用SPSS17.0软件进行统计分析。72例(86.7%)儿童年龄小于3岁。从误吞到入院的时间为1小时至2个月,中位时间为8小时。在我院首诊的63例患儿中,最常见的临床症状为恶心呕吐(32例,50.8%)、吞咽困难(31例,49.2%)、流涎(11例,17.5%)和发热(10例,15.9%)。83例中有73例进行了完整的术前诊断检查,55例(75.3%)通过X线确诊。56例(76.7%)异物嵌顿于食管上段。72例(86.7%)通过硬质食管镜取出异物。23例(27.7%)出现严重并发症,其中气管食管瘘15例(65.2%)、声带麻痹8例(34.8%)、食管穿孔3例(13.0%)、出血3例(13.0%)、纵隔炎3例(13%)、食管周围脓肿1例(4.3%)。并发症组异物暴露时间及监护人未目睹误吞情况差异有统计学意义(<0.05)。2例(2.4%)分别因动脉食管瘘出血及气管食管瘘治疗期间支架移位致呼吸衰竭死亡。误吞纽扣电池可危及生命,多发生于3岁以下儿童。非特异性临床表现及未目睹误吞情况可能导致严重并发症。胸部正侧位X线是首选检查方法。气管食管瘘是最常见的严重并发症。

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