Sun Song,Zhu Ye,Dong Kuiran,et al.Treatment of esophageal perforation caused by foreign bodies in children: single center clinical experience[J].Journal of Clinical Pediatric Surgery,,18():456-461.[doi:10.3969/j.issn.1671-6353.2019.06.005]
Treatment of esophageal perforation caused by foreign bodies in children: single center clinical experience
- Keywords:
- Hernia; Hiatal/TH; Foreign Bodies; Clinical Protocols; Child
- CLC:
- R768.3+2;R768.3;R655.4
- Abstract:
- Objective As a rare pediatric disease,esophageal perforation may lead to such a fatal complication as mediastinal infection.Currently there is no consensus on its treatment. Methods Retrospective analysis was performed for clinical data of 15 children with esophageal perforation caused by foreign body between January 1,2013 and December 31,2018.And the types of foreign body,major symptoms,short/long-term complications,surgical interventions and prognosis were summarized.Results The most common foreign bodies included button batteries (n=5),fish bones (n=4) and coins (n=3).Major presenting symptoms included fever (n=9),bucking (n=8),cough with sputum (n=8),dysphagia (n=6),refusal of food (n=5) and neck swelling (n=4).And the site of perforation was upper (n=12),middle (n=1) and lower (n=2).Severe infections occurred in 12 of them.And the most common complications were pneumonia (n=10),cervical soft tissue infection (n=7) and mediastinal infection (n=5).Surgical drainage of neck or mediastinal abscess was performed in 5 cases.Thoracotomic removal of abscess and foreign body was performed in 2 cases due to inadequate drainage of thoracic empyema.Two cases were treated with titanium clip under gastroscope.The procedures included gastrostomy (n=8),jejunal nutrition tube implantation (n=4) and nasogastric tube implantation under gastroscope (n=2).Esophageal perforation healed spontaneously in 11 children,3 cases of esophageal stenosis were cured by dilatation and 1 child underwent pyloroplasty due to gastroparesis.Esophagotracheal fistula repair was performed in 2 cases after 3-6 months.One case of continuous esophageal pleural fistula was cured by esophageal stent implantation.One child died from infection.Ten children were followed up for 3 months to 2 years and there was no other complication. Conclusion Button batteries,fish bones and coins are the most common foreign bodies causing esophageal perforation in children.Fever,bucking,cough and other respiratory symptoms are early warning signs of esophageal perforation.Most esophageal perforations heal without surgical repair and surgical intervention is limited to removing foreign bodies and draining abscesses.Titanium clip occlusion in early stage may aid the healing of esophageal perforation.With reasonable treatments,most children with esophageal perforation caused by foreign bodies may obtain an excellent prognosis.
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Memo
收稿日期:2019-04-20。
基金项目:国家自然科学基金（编号：81700450）；第四批上海市青年医师培养资助计划
通讯作者:郑珊,Email:szheng@shmu.edu.cn;陈功,Email:1973.cc@163.com