Velitchkov N G, Grigorov G I, Losanoff J E, Kjossev K T
Department of Emergency Surgery, Military Medical Academy, 3 Georgi Sofijski Boulevard, 1606 Sofia, Bulgaria.
World J Surg. 1996 Oct;20(8):1001-5. doi: 10.1007/s002689900152.
Ingested foreign bodies (FBs) present a common clinical problem. As the incidence of FBs requiring operative removal varies from 1% to 14%, it was decided to perform this study and compare the data with those from the world literature, as well as to outline an algorithm for management, including indications for surgery. We reviewed all patients with FB ingestion from 1973 to 1993. There were 542 patients with 1203 ingestions, aged 15 to 82 years. Among them, 69. 9% (n = 379) were jail inmates at the time of ingestion, 22.9% (n = 124) had a history of psychosis, and 7.2% (n = 39) were alcoholics or denture-wearing elderly subjects. Most foreign bodies passed spontaneously (75.6%; n = 410). Endoscopic removal was possible in 19. 5% (n = 106) and was not associated with any morbidity. Only 4.8% (n = 26) required surgery. Of the latter, 30.8% (n = 8) had long gastric FBs with no tendency for distal passage and were removed via gastrotomy; 15.4% (n = 4) had thin, sharp FBs, causing perforation; and 53.8% (n = 14) had FBs impacted in the ileocecal region, which were removed via appendicostomy. Conservative approach to FB ingestion is justified, although early endoscopic removal from the stomach is recommended. In cases of failure, surgical removal for gastric FBs longer than 7.0 cm is wise. Thin, sharp FBs require a high index of suspicion because they carry a higher risk for perforation. The ileocecal region is the most common site of impaction. Removal of the FB via appendicostomy is the safest option and should not be delayed more than 48 hours.
摄入异物是一个常见的临床问题。由于需要手术取出异物的发生率在1%至14%之间，因此决定开展本研究，并将数据与世界文献中的数据进行比较，同时概述一种管理算法，包括手术指征。我们回顾了1973年至1993年期间所有摄入异物的患者。共有542例患者发生1203次异物摄入，年龄在15至82岁之间。其中，69.9%（n = 379）在摄入异物时为监狱囚犯，22.9%（n = 124）有精神病病史，7.2%（n = 39）为酗酒者或佩戴假牙的老年患者。大多数异物可自行排出（75.6%；n = 410）。19.5%（n = 106）的患者可行内镜取出，且未出现任何并发症。仅4.8%（n = 26）的患者需要手术。在后者中，30.8%（n = 8）有较长的胃内异物且无向远端排出的趋势，通过胃切开术取出；15.4%（n = 4）有细长尖锐的异物，导致穿孔；53.8%（n = 14）的异物嵌顿在回盲部，通过阑尾造口术取出。对于异物摄入采取保守方法是合理的，尽管建议早期从胃内进行内镜取出。在失败的情况下，对于长度超过7.0 cm的胃内异物进行手术取出是明智的。细长尖锐的异物需要高度怀疑，因为它们穿孔风险较高。回盲部是最常见的嵌顿部位。通过阑尾造口术取出异物是最安全的选择，不应延迟超过48小时。
