Webb W A
University of South Alabama School of Medicine, Mobile, USA.
Gastrointest Endosc. 1995 Jan;41(1):39-51. doi: 10.1016/s0016-5107(95)70274-1.
Management of 242 foreign bodies of the upper gastrointestinal tract are reported. Thirty-nine were in the pharynx, 181 in the esophagus, 19 in the stomach, and 3 in the small bowel. The flexible panendoscope was used 211 times (87.2%) to manage these foreign bodies, while the rigid esophagoscope was used 12 times (5.0%). Two hundred thirty-nine foreign bodies (98.8%) were successfully managed endoscopically. The surgery rate was 0.4%. There was no morbidity or mortality. Twenty-five percent of the cases were done under general endotracheal anesthesia. Coins in the esophagus are removed promptly if in the cervical or mid esophagus, and within 12 hours if in the distal esophagus. Once in the stomach, they will usually pass without difficulty. Meat impaction resulting in an obstructed esophagus is an urgent problem and the bolus should be removed within hours. Sharp and pointed foreign bodies can be very difficult to manage. Dry runs with a reproduction of the foreign body are essential to successful removal. Button batteries lodged in the esophagus represent an emergency and should be removed without delay. Once in the stomach, they will usually pass through the gastrointestinal tract without difficulty. The forward-viewing flexible panendoscope has become the instrument of choice in managing foreign bodies in most tertiary medical centers as well as in the community hospitals.
本文报告了242例上消化道异物的处理情况。其中39例位于咽部，181例位于食管，19例位于胃，3例位于小肠。使用可弯曲的泛内镜处理这些异物211次（87.2%），而使用硬质食管镜12次（5.0%）。239例异物（98.8%）通过内镜成功处理。手术率为0.4%。无并发症或死亡病例。25%的病例在全身气管内麻醉下进行。食管内的硬币如果位于颈部或食管中段应立即取出，如果位于食管远端则应在12小时内取出。一旦进入胃内，通常会顺利通过。导致食管梗阻的肉块嵌塞是一个紧急问题，应在数小时内取出团块。尖锐和带尖的异物很难处理。对异物进行模拟操作的预演对成功取出至关重要。滞留在食管内的纽扣电池是紧急情况，应立即取出。一旦进入胃内，它们通常会顺利通过胃肠道。在大多数三级医疗中心以及社区医院，直视可弯曲泛内镜已成为处理异物的首选器械。
