Wang Ping,Li Yun,Luo Xinyou,et al.The therapeutic effect for 22 children with esophageal foreign bodies of button battery[J].Journal of Clinical Pediatric Surgery,2019,18(06):467-471.[doi:10.3969/j.issn.1671-6353.2019.06.007]
22例纽扣式电池食管异物患儿治疗效果分析
- Title:
- The therapeutic effect for 22 children with esophageal foreign bodies of button battery
- Keywords:
- Esophagus; Foreign Bodies; Treatment Outcome; Child
- 分类号:
- R768.3+2;R655.4;R571+.1
- 摘要:
- 目的 总结儿童纽扣式电池食管异物患儿的临床特征、并发症及治疗措施，为制定儿童食管异物规范化诊疗方案提供依据。方法 回顾性收集2013年1月至2019年1月由湖南省儿童医院收治的22例纽扣式电池食管异物患儿作为研究对象，其中男童12例，女童10例，中位年龄30.5个月。19例（86.36%）发生吞咽困难，17例（77.27%）发生呕吐，5例（22.73%）发生流涎，1例（4.55%）发生恶心。病史2 h至6个月，异物滞留时间 < 6 h 6例，6~24 h 5例，24~48 h 3例，≥ 48 h 8例。异物崁顿在食管上段者14例，食管中段者3例，食管下段者5例。结果 22例患儿中19例（86.36%）治愈出院，2例（9.09%）好转出院，1例（4.55%）死亡。21例（95.45%）发生食管黏膜糜烂，12例（54.55%）发生食管周围炎，3例（13.64%）发生食管穿孔（食管气管瘘），2例（9.09%）发生食管狭窄，1例（4.55%）发生大出血。纽扣式电池食管异物所致并发症发生率最高是食管黏膜糜烂，其次是食管周围炎、食管穿孔、食管狭窄、大出血。3例食管穿孔中有1例经增强营养及控制感染后自然愈合，1例于胸外科予食管穿孔修补术后痊愈出院，1例合并食管穿孔及食管气管瘘发生大出血死亡。食管气管瘘2例中有1例于外院行胃造瘘及食管旷置术，1例食管气管瘘患儿尚在随访观察中；食管狭窄2例已行食管扩张术，其中1例疗效欠佳尚在随访观察中； 结论 纽扣式电池食管异物的常见并发症是食管黏膜糜烂、食管周围炎，更为严重者可以发生食管穿孔、食管狭窄，甚至大出血死亡。对于该类患儿应尽快就医、尽早手术、采用正确有效的护理措施、加强病情观察、定期随访，这样可降低并发症发生率，有效改善其预后。
- Abstract:
- Objective To explore the complications and outcomes of children with esophageal foreign body of button battery. Methods Retrospective analysis was conducted for the clinical data of 22 children hospitalized with esophageal foreign bodies of button battery from January 2013 to January 2019. There were 12 boys and 10 girls with a median age of 30.5 months. The presenting symptoms included dysphagia (n=19), vomiting (n=17), salivation (n=5) and nausea (n=1). The length of disease course was 2 hours to 6 months. And the indwelling time of foreign body was <6 h (n=6), 6-24 h (n=5), 24-48 h (n=3) and ≥ 48 h (n=8). The impaction sites were upper (n=14), middle (n=3) and lower (n=5) esophagus. Results The complications were esophageal mucosal erosion (n=21), esophageal inflammation (n=12), esophageal perforation with tracheal esophageal fistula (n=3), esophageal stricture (n=2), esophageal stenosis (n=2) and hemorrhage (n=1). The outcomes were cure (n=19), discharge after improvement (n=2) and death (n=1). One case of esophageal perforation naturally healed after strengthening nutrition and infection control. Another one was discharged after thoracic surgery for repairing esophageal perforation. One case of tracheal esophageal fistula was operated at another hospital while another one was still under follow-ups. Two cases of esophageal stenosis underwent esophageal dilation while another one was still under observations. One mortality occurred due to massive hemorrhage. Conclusion Foreign body of button battery causes great damage to esophageal wall and whole body. Medical care should be sought as soon as possible. Prompt and effective treatments, strengthening observations and regular follow-ups after discharge may reduce the incidence rate of complications and improve the outcomes.
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备注/Memo
收稿日期:2019-04-30。
基金项目:湖南省自然科学基金（编号：2019JJ80043）
通讯作者:罗欣友,Email:Luoxinyou 1972@sina.com